81 Outcomes of multi-target therapy using mycophenolate mofetil and tacrolimus for refractory lupus nephritis

Background and aims Outcomes of systemic lupus erythematosus (SLE) has significantly improved over the years. However, it can still be unfavourable when there is major organ involvement such as lupus nephritis and standard therapies fail. Outcomes of multi-target therapy using mycophenolate mofetil (MMF) and tacrolimus in SLE patients who were refractory to standard therapy was assessed. Methods Retrospective analysis was done in patients with biopsy-confirmed lupus nephritis class III or IV who failed to achieve complete response with standard induction therapy for 24 weeks and switched to multi-target combination therapy with MMF and tacrolimus. Outcomes including renal response, urine protein/creatinine ratio (UPCR), glomerular filtration rate (GFR), serum albumin, and complements were assessed at 24 weeks. Results A total of 20 patients, with mean age of 27.9±8.2 years and 82.8% female, who initiated MMF and tacrolimus combination therapy were included. At 24 weeks, 25.9% showed complete response and 37.0% showed partial response. When all patients were compared, the mean UPCR increased from 3.06±3.00 at baseline to 3.21±4.23 at 24 weeks and GFR declined from 96.55±37.07 mL/min/1.73m 2 to 92.00±41.12 mL/min/1.73m 2 . But in subgroup comparison, UPCR decreased from 1.82±0.86 to 1.39±0.85 in patients who had shown partial response to standard induction therapy and increased from 5.61±2.93 to 8.62±4.11 in no response patients. Conclusions Multi-target therapy combining MMF and tacrolimus can be considered in patients who had partial response to standard induction therapy in patients with lupus nephritis.