Glucocorticoid Monotherapy as Induction Therapy for Class 1/2 Lupus Nephritis Is Associated with Higher Renal Relapse and Poorer Kidney Outcomes

Background: For class I/II lupus nephritis (LN), the efficacy of immunosuppressive therapy is less clear. Methods: A total of 128 patients with first biopsy-proven class I/II LN were included and divided into glucocorticoid alone induction therapy (GC monotherapy) group and GC in combination with other immunosuppressant induction therapy (combination therapy) group according to treatment regimens for induction therapy. The rates of remission, relapse, end-stage renal disease (ESRD), and risk factors related to the outcomes were analyzed. Results: During the median follow-up of 94 (IQR 30–169) months, all the 96 patients achieved remission. Renal relapse occurred in 37 cases (38.9%), of which 20 (51.3%) were in GC monotherapy group and 17 (30.4%) were in combination therapy group. Kaplan-Meier curve showed that the cumulative renal relapse rate in the GC monotherapy group was much higher than that in the combination group (p = 0.0036). GC monotherapy was significantly associated with higher renal relapse (hazard ratio (HR) = 2.526, 95% confidence interval (CI) 1.211–5.267, p = 0.013). Multivariate cox regression analyses showed that partial remission (HR = 4.073, 95% CI 1.760–9.425, p = 0.001) and GC monotherapy (HR = 2.502, 95% CI 1.145–5.466, p = 0.021) were independent risk factors for class I/II LN renal relapse. The median follow-up time with ESRD as the endpoint was 151 (IQR 76–193) months. At the end of follow-up, 5 (4.7%) patients developed ESRD, all of whom were in GC monotherapy group. The 10-year, 15-year, 20-year and 25-year renal survival rates for class I/II lupus nephritis were 99%, 95%, 95%, and 90%, respectively, with GC monotherapy group had significantly poorer long-term renal outcomes (91.7% vs 100%, 87% vs 100%, 87% vs 100%, 65% vs 100%, P=0.010). Conclusion: Patients with class I/II LN treated with glucocorticoid induction therapy alone have higher renal relapse rate and poor long-term renal prognosis. Prospective randomized controlled trial studies with large samples are necessary to further explore the clinical benefits of combination therapy in the treatment of class I/II LN.