Immunosuppressant Withdrawal Possible for Patients in Remission From LN

Immunosuppressive therapy can be safely withdrawn in certain patients with lupus nephritis who have achieved remission, according to a study published in the journal Rheumatology.

Researchers came to the conclusion after assessing flare rates and flare predictors in 83 patients with biopsy-proven lupus nephritis who achieved remission and subsequently discontinued immunosuppressants.

Over a mean follow-up of nearly 10 years after discontinuing immunosuppressive therapy, 22.9% of patients developed a flare and were retreated. Approximately three-quarters of them, however, achieved lupus nephritis remission again after restarting immunosuppressants, according to the study. Patients who continued immunosuppressive therapy for at least 3 years after remission had the lowest relapse risk.

Multivariate logistic regression analysis identified a trio of factors that protected against disease flare after stopping immunosuppressive therapy: antimalarial maintenance therapy (researchers reported 0.194 odds ratio), age at immunosuppressant discontinuation (0.93 odds ratio), and a remission duration of more than 3 years before immunosuppressant discontinuation (0.231 odds ratio).

“Withdrawal of immunosuppressants is feasible in lupus nephritis patients in remission for at least 3 years and on antimalarial therapy,” researchers wrote. “Patients who experience flares can re-achieve remission with an appropriate treatment.”

—Jolynn Tumolo

Reference:
Zen M, Fuzzi E, Loredo Martinez M, et al. Immunosuppressive therapy withdrawal after remission achievement in patients with lupus nephritis. Rheumatology. 2022;61(2):688-695.