RESEARCH - Current therapies for lupus nephritis in an ethnically heterogeneous cohort

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J Rheumatol. 2008 Dec 1.

Current Therapies for Lupus Nephritis in an Ethnically Heterogeneous Cohort.

TL, Belmont HM, Malani S, Latorre M, Benton L, Weisstuch J,

Barisoni L, Tseng CE, Izmirly PM, Buyon JP, Askanase AD.

From New York University School of Medicine; Downtown Hospital, New

York; SUNY Downstate, Brooklyn; and Columbia University, New York, New

York, USA.

OBJECTIVE: To evaluate responses to mycophenolate mofetil (MMF) and

intravenous cyclophosphamide (CYC) in lupus nephritis in a multiethnic

population.

METHODS: This was a retrospective study of all patients with systemic

lupus erythematosus (SLE) that underwent kidney biopsy at New York

University Medical Center. Patients with followup of at least 6 months

were included. Clinical response was defined as complete (return to

+/- 10% of normal) or partial (improvement of 50% in abnormal renal

measurements).

RESULTS:. Ninty-nine patients were included in the study: 86% females,

86% non-Caucasian, age 34.2 +/- 1.1 years, 62% with proliferative

nephritis (PN; ISN/RPS-III and IV), and 32% with membranous nephritis

(MN; ISN/RPS-V). Of the 70 patients with PN, 37 were treated with CYC

and 33 with MMF. The baseline characteristics of the 2 treatment

groups were different in the incidence of ISN/RPS-IV, values of serum

creatinine and serum albumin, and type of insurance (p < 0.05). The

response rate was greater in the MMF than in the CYC group (70% vs

41%). Responses to MMF were different in Asians (11/11), Caucasians

(4/5), African Americans (3/5), and Hispanics (5/11). Responses to CYC

had a similar distribution (Asians 6/10, Caucasians 4/5, African

American 4/9, Hispanics 1/11). In the MN group (N = 23) responses were

similar to the PN group (73% MMF and 38% CYC). After adjusting for

race, serum creatinine, serum albumin, type of insurance, and class of

nephritis, in a logistic regression model, response to MMF was

superior to CYC: OR 6.2 (95% CI 1.9-20.2). Hispanics had worse outcome

than Caucasians (OR 0.17). Longterm followup suggested no difference

in maintenance with MMF or CYC.

CONCLUSION: After controlling for the fact that less severe nephritis

is preferentially treated with MMF, we found overall that response to

MMF was superior to CYC. In this US population, ethnicity was observed

to have an influence on response.

PMID: 19040310

http://www.ncbi.nlm.nih.gov/pubmed/19040310

Not an MD