Abstract
ObjectiveWe sought to evaluate the effect of antiplatelet therapy in addition to conventional immunosuppressive therapy for lupus nephritis (LN) patients positive for antiphospholipid antibodies (aPL) without definite antiphospholipid syndrome (APS).MethodsPatients with biopsy-proven LN class III or IV were retrospectively evaluated. We selected patients positive for anticardiolipin antibody (aCL) or lupus anticoagulant (LA) who did not meet the criteria for a diagnosis of APS. The patients were divided into two subgroups according to whether antiplatelet therapy was received. The cumulative complete renal response (CR) rate, relapse-free rate, and change in estimated glomerular filtration rate (eGFR) over 3 years after induction therapy were calculated.ResultsWe identified 17 patients who received antiplatelet therapy and 21 who did not. Baseline clinicopathological characteristics and immunosuppressive therapy did not show a significant difference between the two groups except for a higher incidence of LN class IV in the treatment group (p = 0.03). There was no difference in cumulative CR rate, relapse-free rate, or eGFR change between these subgroups. However, when data on LA-positive patients were assessed, an improvement in eGFR was found (p = 0.04) in patients receiving antiplatelet treatment.ConclusionAddition of anti-platelet therapy was associated with an improvement of eGFR in LA-positive patients with LN class III or IV.
Highlights
Lupus nephritis (LN) contributes to significant morbidity and mortality in systemic lupus erythematosus (SLE) [1, 2]
We identified 17 patients who received antiplatelet therapy and 21 who did not
Addition of anti-platelet therapy was associated with an improvement of estimated glomerular filtration rate (eGFR) in lupus anticoagulant (LA)-positive patients with LN class III or IV
Summary
Lupus nephritis (LN) contributes to significant morbidity and mortality in systemic lupus erythematosus (SLE) [1, 2]. APS is reported to worsen the prognosis of LN [4]. Based on its contribution to the renal outcome, the American College of Rheumatology (ACR) recently published recommendations for LN management [5], under which LN patients with APS should be treated with conventional immunosuppressive treatment plus antiplatelet or anticoagulation therapy. It has been reported that the presence of anticardiolipin antibodies (aCL) is a strong predictor of worse long-term renal outcome in LN regardless of whether the criteria for an APS diagnosis are met [6, 7], the renoprotective effect of antiplatelet therapy has not been evaluated. We analyzed the effect of adding antiplatelet agents to conventional immunosuppressive therapy for LN patients who were positive for aCL or lupus anticoagulant (LA) without definite APS
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