FRI0188 EARLY RENAL IMPROVEMENTS FOLLOWING RITUXIMAB IN LUPUS NEPHRITIS

Background Rituximab (RTX) is the monoclonal antibody of choice in patients with lupus nephritis (LN) who either fail to respond to, or cannot receive standard of care (SOC) therapy. Despite its continued use in clinical practice, published clinical trials regarding its use in LN management have failed to show any clear benefit. Objectives We aimed to analyse renal outcomes of LN patients in a large national register. Methods Patients with active LN on recruitment into the BILAG-Biologics Register (BILAG-BR) were included. Active LN was defined as a BILAG A or B score in the renal domain. Patients are eligible for RTX if they have failed either MMF or cyclophosphamide. We defined renal response at 6 and 12 months as a change in BILAG score from A to B/C/D or B to C/D. Non-renal disease activity was also described. Results Overall 259/897 patients in BILAG-BR had active LN at baseline. Of these, 230 received RTX and 29 received SOC. 109/159 (68.6%) RTX patients and 15/19 (78.9%) of SOC patients had a renal BILAG response at 6 months (p=0.792) (Table 1). In those with sufficient response data at 12 months, 31/98 (31.6%) and 7/15 (46.7%) (p=0.084) demonstrated continued renal response in the RTX and SOC groups respectively. Both groups made improvements or remained stable in all other renal domains (UPCR, eGFR, creatinine) at 6 and 12 months. Oral steroid doses decreased in both treatment groups. Of note, baseline steroid doses in the SOC group were higher than RTX patients (30mg (20-40) vs. 12.5mg (10-25), p<0.001). Non-renal disease activity measures improved in both cohorts. Conclusion In a large UK-wide, real-world, observational LN cohort we have shown that RTX does improve renal outcomes at 6 and 12 months in refractory SLE patients. RTX is a valid treatment option for many patients with renal disease in SLE. Disclosure of Interests Sophie Collinson: None declared, Ben Parker Grant/research support from: GSK, Consultant for: AZ, UCB, GSK, Eoghan McCarthy: None declared, Ian N. Bruce Grant/research support from: Genzyme Sanofi, GlaxoSmithKline, Consultant for: AstraZeneca, Eli Lilly, GlaxoSmithKline, ILTOO Pharma, MedImmune, Merck Serono, Speakers bureau: GlaxoSmithKline, UCB Pharma