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Hi, my name is Al Kim from WashU Medicine in St.
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Louis, Missouri, where I direct the Lupus Center there, and I'm here at ACR 2025 Convergence in Orlando, Florida.
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The topic I want to talk about today is the concept of remission, because there's a bunch of abstracts here that challenge our way of
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thinking about remission — not necessarily it being a single state, but actually multiple different variables within a possible single state, and they don't always
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agree.
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So I want to first start in the tissue. The repeat biopsy data, which is abstract 1862, entitled "Post-Treatment Proteinuria Poorly Predicts Histologic Remission in
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Lupus Nephritis" — I think you know what I mean when I just said that title — they have very clear evidence that post-treatment proteinuria
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is very poorly correlative with histologic remission.
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And this builds on prior post hoc data analyses done within the REGENCY trial, which was the phase three obinutuzumab lupus nephritis trial, where we're also seeing some discordances.
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So the beautiful thing about these type of studies is that the biopsies were obtained on a per-protocol basis, so they've been very tightly and well-timed.
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Abstract 1863 extends on this one, entitled "Quantifying the Impact of Histologic Activity on Proteinuria and Renal Outcomes in Lupus Nephritis."
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As the title also suggests, they found that the majority of proteinuric values don't necessarily associate with histological remission at the tissue level, and again extending on several other observations in the past.
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So really, taken together, we are just gathering more and more evidence about how poor conventional urinary biomarkers are for assessing lupus nephritis monitoring.
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Then there is a third axis that neither of those other two abstracts captures.
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This is abstract 1232, "Obinutuzumab Facilitates Tubular Repair in LN Independent of Histologic or Clinical Response."
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This is another post hoc analysis of that REGENCY trial I had just previously mentioned.
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What they show is that tubular repair, as measured by urinary EGF, and this repair is independent of histologic activity.
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Think about that — you could have someone with active disease but no EGF in the kidney and have no repair.
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You can have someone with histologic remission but no EGF in the urine, which also means they aren't repairing.
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They could also have active disease but have EGF in the urine, which indicates repair.
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You can see how complicated this is getting, and it's a really interesting way to think about how we are starting to measure remission — not just in terms of injury, but also in terms of repair.
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