PMID- 19933596
OWN - NLM
STAT- MEDLINE
DCOM- 20101105
LR  - 20220419
IS  - 1462-0332 (Electronic)
IS  - 1462-0324 (Print)
IS  - 1462-0324 (Linking)
VI  - 49
IP  - 1
DP  - 2010 Jan
TI  - Influence of race/ethnicity on response to lupus nephritis treatment: the ALMS 
      study.
PG  - 128-40
LID - 10.1093/rheumatology/kep346 [doi]
AB  - 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.
FAU - Isenberg, David
AU  - Isenberg D
AD  - Centre for Rheumatology, University College London, London, UK.
FAU - Appel, Gerald B
AU  - Appel GB
FAU - Contreras, Gabriel
AU  - Contreras G
FAU - Dooley, Mary A
AU  - Dooley MA
FAU - Ginzler, Ellen M
AU  - Ginzler EM
FAU - Jayne, David
AU  - Jayne D
FAU - Sanchez-Guerrero, Jorge
AU  - Sanchez-Guerrero J
FAU - Wofsy, David
AU  - Wofsy D
FAU - Yu, Xueqing
AU  - Yu X
FAU - Solomons, Neil
AU  - Solomons N
LA  - eng
SI  - ClinicalTrials.gov/NCT00377637
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20091120
PL  - England
TA  - Rheumatology (Oxford)
JT  - Rheumatology (Oxford, England)
JID - 100883501
RN  - 0 (Immunosuppressive Agents)
RN  - 8N3DW7272P (Cyclophosphamide)
RN  - HU9DX48N0T (Mycophenolic Acid)
RN  - VB0R961HZT (Prednisone)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Child
MH  - Cyclophosphamide/adverse effects/therapeutic use
MH  - Drug Administration Schedule
MH  - Drug Therapy, Combination
MH  - Humans
MH  - Immunosuppressive Agents/adverse effects/*therapeutic use
MH  - Lupus Nephritis/complications/*drug therapy/*ethnology
MH  - Middle Aged
MH  - Mycophenolic Acid/adverse effects/analogs & derivatives/therapeutic use
MH  - Opportunistic Infections/complications/ethnology
MH  - Prednisone/adverse effects/therapeutic use
MH  - Prospective Studies
MH  - Treatment Outcome
MH  - Young Adult
PMC - PMC2789586
EDAT- 2009/11/26 06:00
MHDA- 2010/11/06 06:00
PMCR- 2009/11/20
CRDT- 2009/11/26 06:00
PHST- 2009/11/26 06:00 [entrez]
PHST- 2009/11/26 06:00 [pubmed]
PHST- 2010/11/06 06:00 [medline]
PHST- 2009/11/20 00:00 [pmc-release]
AID - kep346 [pii]
AID - 10.1093/rheumatology/kep346 [doi]
PST - ppublish
SO  - Rheumatology (Oxford). 2010 Jan;49(1):128-40. doi: 10.1093/rheumatology/kep346. 
      Epub 2009 Nov 20.