Influence of race/ethnicity on response to lupus nephritis treatment: the ALMS study.

David Isenberg, Gerald B. Appel, Gabriel Contreras, Mary A. Dooley, Ellen M. Ginzler, David Jayne, Jorge Sánchez-Guerrero, David Wofsy, Xueqing Yu, Neil Solomons

Research output: Contribution to journalArticle

194 Scopus citations

Abstract

OBJECTIVE: To compare the efficacy and safety of mycophenolate mofetil (MMF) and intravenous cyclophosphamide (IVC) as induction treatment for lupus nephritis (LN), by race, ethnicity and geographical region. METHODS: A total of 370 patients with active Class III-V LN received MMF (target dose 3.0 g/day) or IVC (0.5-1.0 g/m(2)/month), plus tapered prednisone, for 24 weeks. Renal function, global disease activity, immunological complement (C3 and C4) and anti-dsDNA levels are the outcomes that were assessed in this study. RESULTS: MMF was not superior to IVC as induction treatment (primary objective). There were important pre-specified interactions between treatment and race (P = 0.047) and treatment and region (P = 0.069) (primary endpoint). MMF and IVC response rates were similar for Asians (53.2 vs 63.9%; P = 0.24) and Whites (56.0 vs 54.2%; P = 0.83), but differed in the combined Other and Black group (60.4 vs 38.5%; P = 0.03). Fewer patients in the Black (40 vs 53.9%; P = 0.39) and Hispanic (38.8 vs 60.9%; P = 0.011) groups responded to IVC. Latin American patients had lower response to IVC (32 vs 60.7%; P = 0.003). Baseline disease characteristics were not predictive of response. The incidence of adverse events (AEs) was similar across groups. Serious AEs were slightly more prevalent among Asians. CONCLUSIONS: MMF and IVC have similar efficacy overall to short-term induction therapy for LN. However, race, ethnicity and geographical region may affect treatment response; more Black and Hispanic patients responded to MMF than IVC. As these factors are inter-related, it is difficult to draw firm conclusions about their importance.

Original languageEnglish (US)
Pages (from-to)128-140
Number of pages13
JournalRheumatology (Oxford, England)
Volume49
Issue number1
DOIs
StatePublished - Jan 2010

ASJC Scopus subject areas

  • Rheumatology
  • Pharmacology (medical)

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    Isenberg, D., Appel, G. B., Contreras, G., Dooley, M. A., Ginzler, E. M., Jayne, D., Sánchez-Guerrero, J., Wofsy, D., Yu, X., & Solomons, N. (2010). Influence of race/ethnicity on response to lupus nephritis treatment: the ALMS study. Rheumatology (Oxford, England), 49(1), 128-140. https://doi.org/10.1093/rheumatology/kep346