Big Drop in Lupus Nephritis Deaths Documented

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ATLANTA—Mortality rates from lupus nephritis have decreased significantly since 1975 but have leveled off over the past 10 years, British researchers found.

If further improvements in mortality are to be achieved, new drug regimens need to be considered, they noted.

Lupus nephritis is one of the most common and potentially severe complications of systemic lupus erythematosus. Few long-term follow-up data are available. David Isenberg, MD, Academic Director of Rheumatology at University College London, and colleagues analyzed long-term outcomes of 156 lupus nephritis patients at University College London Hospital between 1975 and 2005.

The researchers divided the cohort into three groups according to the decade in which they were diagnosed (1975-1985, 1986-1996, and 1996-2005). Subjects were followed up for a minimum of five years. The researchers compared clinical, demographic and serological characteristics, and clinical outcomes (five-year mortality rate or the development of end-stage renal disease (ESRD). The three groups had comparable clinical characteristics.

The five-year mortality rate decreased by 60% between the first decade and the second decade and then stabilized throughout the third decade, Dr. Isenberg reported. The five-year ESRD rate remained constant during the entire study period. 

Increasing numbers of renal transplants were performed over time, with encouraging results, particularly when a living-related donor graft was used. Still, Dr. Isenberg said, once ESRD developed, the prognosis was variable.

He said he believes the outcomes achieved today are as good as they are going to get with the available conventional treatments. “If we are going to further improve the outcomes of our patients we need to address issues of compliance and quite possibly the use of biological therapies,” he said.

The researchers presented their findings at the American College of Rheumatology annual meeting.

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