Weaning of maintenance immunosuppressive therapy in lupus nephritis (WIN-Lupus): results of a multicentre randomised controlled trial

Noemie Jourde-Chiche (1) , Nathalie Costedoat-Chalumeau , Karine Baumstarck , Anderson Loundou , Laurence Bouillet , Stéphane Burtey (1) , Valérie Caudwell , Laurent Chiche , Lionel Couzi , Laurent Daniel (1) , Christophe Deligny , Bertrand Dussol , Stanislas Faguer , Pierre Gobert , Guillaume Gondran , Antoine Huart , Aurélie Hummel , Emilie Kalbacher , Adexandre Karras , Marc Lambert , Véronique Le Guern , Ludivine Lebourg , Sandrine Loubière , Hélène Maillard-Lefebvre , François Maurier , Micheline Pha , Viviane Queyrel , Philippe Remy , Françoise Sarrot-Reynauld , David Verhelst , Eric Hachulla , Zahir Amoura , Eric Daugas

1 C2VN - Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research

ObjectivesLupus nephritis (LN) is a frequent complication of systemic lupus erythematosus (SLE). Severe (proliferative) forms of LN are treated with induction immunosuppressive therapy (IST), followed by maintenance IST, to target remission and avoid relapses. The optimal duration of maintenance IST is unknown. The WIN-Lupus trial tested whether IST discontinuation after 2‒3 years was non-inferior to IST continuation for two more years in proliferative LN.MethodsWIN-Lupus was an investigator-initiated multicentre randomised controlled trial. Patients receiving maintenance IST with azathioprine or mycophenolate mofetil for 2–3 years, and hydroxychloroquine, were randomised (1:1) into two groups: (1) IST continuation and (2) IST discontinuation. The primary endpoint was the relapse rate of proliferative LN at 24 months. Main secondary endpoints were the rate of severe SLE flares, survival without renal relapse or severe flare, adverse events.ResultsBetween 2011 and 2016, 96 patients (out of 200 planned) were randomised in WIN-Lupus: IST continuation group (n=48), IST discontinuation group (n=48). Relapse of proliferative LN occurred in 5/40 (12.5%) patients with IST continuation and in 12/44 (27.3%) patients with IST discontinuation (difference 14.8% (95% CI −1.9 to 31.5)). Non-inferiority was not demonstrated for relapse rate; time to relapse did not differ between the groups. Severe SLE flares (renal or extrarenal) were less frequent in patients with IST continuation (5/40 vs 14/44 patients; p=0.035). Adverse events did not differ between the groups.ConclusionsNon-inferiority of maintenance IST discontinuation after 2‒3 years was not demonstrated for renal relapse. IST discontinuation was associated with a higher risk of severe SLE flares.Trial registration numberNCT01284725.

Keywords: Lupus Nephritis; Hydroxychloroquine; Glucocorticoids; Lupus Erythematosus; Systemic; Outcome Assessment; Health Care

Domains: Life Sciences [q-bio]

Noemie Jourde-Chiche, Nathalie Costedoat-Chalumeau, Karine Baumstarck, Anderson Loundou, Laurence Bouillet, et al.. Weaning of maintenance immunosuppressive therapy in lupus nephritis (WIN-Lupus): results of a multicentre randomised controlled trial. Annals of the Rheumatic Diseases, 2022, 81 (10), pp.1420-1427. ⟨10.1136/annrheumdis-2022-222435⟩. ⟨hal-03800914⟩