Patients included in the STG and the HTG similarly improved their fatigue, irrespectively of their level of compliance, raising the possibility that the beneficial effect on fatigue was not only exercise-related.

BackgroundFew studies have addressed glucocorticoid (GC) withdrawal in lupus nephritis (LN). Yet, this remains a pivotal issue due to GC-induced side effects on the one hand, and to the risk of relapse on the other hand.ObjectivesWe reviewed the data of the Louvain Lupus Nephritis Inception Cohort (LOULUNIC) i): to determine the percentage of patients able to permanently or transiently stop GC; ii): to compare their baseline and follow-up characteristics to patients who never stopped; and iii): to assess the consequences of GC withdrawal.MethodsNinety patients with new-onset biopsy-proven LN were included. All were under the care of the same senior physician (FAH) during follow-up. Clinical, pathological and biological data were extracted from our data base. The SLICC/ACR-DI was assessed at last visit. Unpaired t-tests, Mann-Whitney tests and ANOVA were used, as appropriate.ResultsOut of 90 patients with incident LN, 43 (48%) ever stopped GC (group E), of which 32 permanently (group P). Median time to stop GC was 37 months. 47 patients (52%) never stopped GC (group N).At baseline, serum creatinine, uP/C ratio, ISN/RPS classes, activity and chronicity indices did not differ between groups, nor did the mean initial dose of methylprednisolone (MP) (N: 28 mg/d; E: 32 mg/d; P: 31 mg/d), the use of IV MP pulses (82 and 77% in N and E groups, respectively) and of IV cyclophosphamide (81 and 77%, respectively).During the first year, mean (SD) uP/C decreased statistically more in group E compared to group N (p=0.028 by ANOVA), with striking differences at month 3 (N: 1.73±1.87; E: 0.96±1.34; p=0.038 by unpaired t-test). This difference at month 3 was also noticed for group P patients (0.85±0.76; p=0.02 by unpaired t-test). Interestingly, the mean MP dose at month 3 was statistically higher in group E (19±8) and P (20±9) compared to group N (15±6) (p=0.005 by unpaired t-test).At last follow-up, serum creatinine was statistically lower in E and P patients compared to N patients. Eight of the 11 patients from the T group suffered form a renal relapse, justifying restart of GC, after a median time of 30 months. Importantly, SLICC/ACR-DI was significantly lower in E and P patients, compared to N patients (p=0.0068 and 0.0027, respectively).ConclusionsIn half of LN patients, complete GC withdrawal is achievable and in one third it can be maintained long term. As expected, patients able to stop GC display less damage at last followup. Patients who were able to stop GC decreased their proteinuria much more promptly during the first year of treatment. Interestingly, they received more GC within the first 3 months of therapy, thereby suggesting that a higher dose of GC during the first 3 months of treatment might be associated with a higher probability of later GC withdrawal.Disclosure of InterestNone declared

BackgroundSeveral studies have demonstrated the pivotal role of glucocorticoids (GC) in damage accrual in lupus patients but very few studies were selectively performed in the subgroup of patients suffering from lupus nephritis (LN).ObjectivesTo define the predictors of damage accrual in a LN population.MethodsWe reviewed the files of the 146 patients with biopsy-proven LN included in the Louvain Lupus Nephritis Cohort. The following data were retrieved: demographics, renal pathology, standard renal parameters at baseline and last followup, treatment, renal relapses and SLICC/ACR-DI over time.ResultsAfter a mean followup period of 124 months, 76/146 patients (52%) had some damage, i. e. a SLICC/ACR-DI ≠ 0. The renal, musculoskeletal, cardiovascular and ocular items were the most represented. By univariate analyses, patients with a SLICC/ACR-DI ≠ 0 were older, had a longer followup, took more GC at one year [methylprednisolone (MP): 8.8 mg/d vs 5.7], had suffered from more renal relapses and had develop more renal impairment, including end-stage renal disease. Similar data were obtained if a different SLICC/ACR-DI cutoff value was used (>1 vs ≤1). In a multivariate analysis, using the logistic likelihood ratio test, only 3 variables independently predicted damage, namely the length of followup, the presence of renal relapses and the MP daily dose taken at one year. By contrast, gender, ethnicity, age of onset, standard renal parameters, renal pathology, starting oral MP daily dose, use of IV MP or IV CY did not predict damage. Time to first SLICC/ACR-DI point was statistically shorter, by Kaplan-Meier survival curves, in patients taking ≥4 mg/d of MP after one year of treatment compared to <4 mg/d. Again the initial dose of MP was not influential. Every additional mg/d of MP taken at one year increased the risk of having a SLICC/ACR-DI ≠ 0 by 26% (HR: 1.26; CI: 1.02–1.55).ConclusionsWe confirm that more than half of LN patients develop damage over time according to the SLICC/ACR-DI. Interestingly, the dose of GC taken at one year (and not the initial dose prescribed) is an independent predictor of damage accrual.Disclosure of InterestNone declared

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