Treatment patterns and outcomes of first lupus nephritis episode over 25 years in two Latin American cohorts

ObjectivesTo compare the treatments used for the first episode of lupus nephritis (LN) in two Latin American cohorts (historical and contemporary) over a 25-year period, and their associations with clinical outcomes.MethodsPatients with biopsy-confirmed first LN episode were classified as non-proliferative (class V) or proliferative (classes III/IV). Sociodemographic, clinical, and treatment variables were described. Propensity score matching was used to examine the associations with four outcomes: mortality, damage accrual (SDI), hospitalization, and end-stage renal disease (ESRD).ResultsA total of 532 SLE patients were included: 362 from GLADEL 1.0 (historical cohort) and 170 from GLADEL 2.0. (contemporary). Compared to GLADEL 1.0, patients in GLADEL 2.0 received lower doses of oral glucocorticoids (GC), more frequently GC pulses and antimalarials but less frequently cyclophosphamide. An increase in the use of mycophenolate mofetil and other immunosuppressants was also observed. In the logistic regression models, SDI was associated with baseline SDI and GC pulses, whereas belonging to the GLADEL 2.0 was a protective factor. Mortality was associated with Mestizo ethnicity and partial health coverage; antimalarial was identified as a protective factor. Hospitalizations were associated with baseline SLEDAI and SDI, follow-up time, and lower educational level. Belonging to the GLADEL 2.0 cohort was protective against the occurrence of ESRD.ConclusionsPatients in the contemporary cohort benefited from advances in treatment strategies, with less cumulative damage and progression to ESRD, although mortality remained unchanged. These improvements likely reflect the increased use of newer therapies, more targeted approaches, in line with current treatment guidelines, and better access to specialized care.

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Publication Details

Journal
Lupus
Published
2026-04-28
DOI
https://doi.org/10.1177/09612033261445765
Primary Topic
Systemic Lupus Erythematosus Research
Type
article
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article

Treatment patterns and outcomes of first lupus nephritis episode over 25 years in two Latin American cohorts

C. Toro Gutiérrez, Evandro Mendes Klumb, Patricia Langjahr, Marina Scolnik et al.
Lupus
Systemic Lupus Erythematosus Research
article

Treatment patterns and outcomes of first lupus nephritis episode over 25 years in two Latin American cohorts

C. Toro Gutiérrez, Evandro Mendes Klumb, Patricia Langjahr, Marina Scolnik, Luciana González Lucero, Guillermo Berbotto, Carlos A. Cañas, Edgard Torres do Reis-Neto, Armando Calvo Quiroz, Margarita Portela Hernández, Martín Rebella, Cecilia Pisoni, Álvaro Danza, Odirlei André Monticielo, Rosana Quintana, Milena Mimica, Federico Zazzetti, María Elena Crespo, Luciana Parente Costa Seguro, Eduardo Kerzberg, Gisela Subils, Claudia S Mora-Trujillo, Ignacio García-Valladares, Hilda Fragoso‐Loyo, Mario Javier Moreno Alvarez, J. Serventi, Luis H. Silveira, Henrique Ataíde Mariz, Lucía Hernández, Nicolás Pérez, Alexis Peralta, Roberto Muñoz Louis, Andrés Cadena Bonfanti, Gustavo Aroca Martínez, Miguel Ángel Saavedra, Carlos Abud-Mendoza, Jorge A Esquivel Valerio, Guillermo Pons-Estel, Ashley Orillion, Manuel F Ugarte-Gil, Astrid Paats, Ana Carolina O S Montandon, Valeria Arturi, Otaduy Cintia, Verónica Saurit, Gerardo Quintana-Lopez, Eloisa Bonfa, Eduardo F Borba, Chetan Karyekar, Graciela S Alarcón, Bernardo A Pons-Estel
article en

Abstract

ObjectivesTo compare the treatments used for the first episode of lupus nephritis (LN) in two Latin American cohorts (historical and contemporary) over a 25-year period, and their associations with clinical outcomes.MethodsPatients with biopsy-confirmed first LN episode were classified as non-proliferative (class V) or proliferative (classes III/IV). Sociodemographic, clinical, and treatment variables were described. Propensity score matching was used to examine the associations with four outcomes: mortality, damage accrual (SDI), hospitalization, and end-stage renal disease (ESRD).ResultsA total of 532 SLE patients were included: 362 from GLADEL 1.0 (historical cohort) and 170 from GLADEL 2.0. (contemporary). Compared to GLADEL 1.0, patients in GLADEL 2.0 received lower doses of oral glucocorticoids (GC), more frequently GC pulses and antimalarials but less frequently cyclophosphamide. An increase in the use of mycophenolate mofetil and other immunosuppressants was also observed. In the logistic regression models, SDI was associated with baseline SDI and GC pulses, whereas belonging to the GLADEL 2.0 was a protective factor. Mortality was associated with Mestizo ethnicity and partial health coverage; antimalarial was identified as a protective factor. Hospitalizations were associated with baseline SLEDAI and SDI, follow-up time, and lower educational level. Belonging to the GLADEL 2.0 cohort was protective against the occurrence of ESRD.ConclusionsPatients in the contemporary cohort benefited from advances in treatment strategies, with less cumulative damage and progression to ESRD, although mortality remained unchanged. These improvements likely reflect the increased use of newer therapies, more targeted approaches, in line with current treatment guidelines, and better access to specialized care.

Lupus
Universidade Federal do Rio Grande (BR), Hospital Británico (UY), Universidade Federal do Rio Grande do Sul (BR), Johnson & Johnson (United States) (US), Mexican Social Security Institute (MX), Universidad Nacional de Córdoba (AR), Universidad Autónoma de Nuevo León (MX), Universidade de São Paulo (BR), Universidad Peruana Cayetano Heredia (PE), Pontificia Universidad Javeriana (CO), Universidade Federal de Pernambuco (BR), Universidad Científica del Sur (PE), Comilla Medical College (BD), Hospital Italiano de Buenos Aires (AR), San Sebastián University (CL), Universidad Espíritu Santo (EC), University of Alabama at Birmingham (US), Centro de Estudios Políticos y Constitucionales (ES), Universidad Nacional de Colombia (CO), National University of Rosario (AR), Hospital Padre Américo (PT), Hospital Fernández (AR), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (MX), Hospital del Salvador (CL), Hospital Universitário Pedro Ernesto (BR), Sociedad Española de Reumatología (ES), Hospital Ramos Mejía (AR), Instituto Nacional de Cardiologia (BR), Hospital Central Dr. Ignacio Morones Prieto (MX), Instituto de Diagnóstico e Investigaciones Metabólicas (AR), Hospital Provincial de Rosario (AR), Hospital Italiano La Plata (AR), Universidad Simón Bolívar (CO), Fundación Santa Fe de Bogotá (CO), Hospital das Clínicas da Universidade Federal de Minas Gerais (BR), Hospital de Especialidades (MX), Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (AR), Hospital Privado (AR), Hospital de Clínicas (UY), Hospital Base Guillermo Almenara Irigoyen (PE), St Martins Hospital (GB), Hospital Universitario Nacional de Colombia (CO), Instituto Nacional de Cardiología (MX), Universidad La República (CL), Universidade Federal de Goiás (BR), Icesi University (CO), Universidad Nacional de Asunción (PY), Universidade Federal de São Paulo (BR)
Johnson and Johnson
Good health and well-being
Openalex Percentile: Top 10%
Systemic Lupus Erythematosus Research
DOISourceOpenAlex
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