Lupus nephritis: Pilot study expanding induction treatment options relying on oral dexamethasone as an alternative to parenteral pulse steroids

BackgroundLupus nephritis (LN) affects over 60% of patients with systemic lupus erythematosus and is a risk factor for progression to end stage kidney disease. Guidelines recommend high dose parenteral methylprednisolone "pulses" for induction, although intravenous pulse therapy has not been rigorously compared to oral therapy. In this observational study, we report the outcomes of 17 patients who initiated therapy for LN with high dose oral dexamethasone.MethodsLN patients treated with oral dexamethasone between December 2021, and January 2025, were identified and baseline characteristics were recorded. Patients were assessed for a complete renal response (CRR, uPCR < 500, eGFR > 80%), satisfactory renal response (SRR, uPCR < 700, eGFR > 80%), or partial renal response (PRR, uPCR ≤ half of baseline uPCR, eGFR > 80%) at 1 year after receipt of dexamethasone. Responses were compared to outcomes in the BLISS-LN, AURORA and REGENCY trials.ResultsSeventeen patients with LN treated with induction dexamethasone were identified. The average age was 40 years old, and 15 patients were female. Six patients were of African ancestry, four Hispanic ethnicity, and three were White. Fourteen patients had proliferative LN. 47% of patients achieved a CRR, 59% obtained a SRR, and 53% obtained a PRR. Renal outcomes compared favorably to outcomes in the active arms of the BLISS-LN, AURORA 1, and REGENCY studies. Biomarkers including C3, C4, and dsDNA antibodies improved throughout the period. Proteinuria declined in 14 of 17 patients.ConclusionPatients with LN initially treated with oral dexamethasone in place of intravenous pulse methylprednisolone achieved responses similar to outcomes in recent LN trials. Dexamethasone is a promising potential oral option to initiate treatment for LN obviating need for parenteral therapy.