Predictors of treatment response in a lupus nephritis population: lessons from the Aspreva Lupus Management Study (ALMS) trial. Issue 1 (31st May 2022)

• Record Type: Journal Article
• Authors: McDonald, Stephen; Yiu, Sean; Su, Li; Gordon, Caroline; Truman, Matt; Lisk, Laura; Solomons, Neil; Bruce, Ian N
• Other Names: author non-byline.; Bruce Ian N author non-byline.; Payne Katherine author non-byline.; Lunt Mark author non-byline.; Peek Niels author non-byline.; Geifman Nophar author non-byline.; Gavan Sean author non-byline.; Armitt Gillian author non-byline.; Doherty Patrick author non-byline.; Prattley Jennifer author non-byline.; Azadbakht Narges author non-byline.; Papazian Angela author non-byline.; Sueur Helen Le author non-byline.; Farrelly Carmen author non-byline.; Richardson Clare author non-byline.; Shabbir Zunnaira author non-byline.; Hewitt Lauren author non-byline.; McHugh Neil author non-byline.; Gordon Caroline author non-byline.; Reynolds John author non-byline.; Young Stephen author non-byline.; Jayne David author non-byline.; Farewell Vern author non-byline.; Su Li author non-byline.; Pickering Matthew author non-byline.; Lightstone Elizabeth author non-byline.; Gilmore Alyssa author non-byline.; Botto Marina author non-byline.; Vyse Timothy author non-byline.; Morris David Lester author non-byline.; D'Cruz D author non-byline.; Vital Edward author non-byline.; Wittmann Miriam author non-byline.; Emery Paul author non-byline.; Beresford Michael author non-byline.; Hedrich Christian author non-byline.; Midgley Angela author non-byline.; Gritzfeld Jenna author non-byline.; Ehrenstein Michael author non-byline.; Isenberg David author non-byline.; Parvaz Mariea author non-byline.; Dunnage Jane author non-byline.; Batchelor Jane author non-byline.; Holland E author non-byline.; Upsall Pauline author non-byline.;
• Is Part Of: Lupus science & medicine. Volume 9:Issue 1(2022)
• Publication Date: 2022-05-31
• Subjects: cyclophosphamide -- treatment -- lupus nephritis; Systemic lupus erythematosus -- Periodicals; 616.772005
• DOI: 10.1136/lupus-2021-000584
• Languages: English
• ISSNs: 2398-8851

Abstract

Abstract : Objectives: To identify predictors of overall lupus and lupus nephritis (LN) responses in patients with LN. Methods: Data from the Aspreva Lupus Management Study (ALMS) trial cohort was used to identify baseline predictors of response at 6 months. Endpoints were major clinical response (MCR), improvement, complete renal response (CRR) and partial renal response (PRR). Univariate and multivariate logistic regressions with least absolute shrinkage and selection operator (LASSO) and cross-validation in randomly split samples were utilised. Predictors were ranked by the percentage of times selected by LASSO and prediction performance was assessed by the area under the receiver operating characteristics (AUROC) curve. Results: We studied 370 patients in the ALMS induction trial. Improvement at 6 months was associated with older age (OR=1.03 (95% CI: 1.01 to 1.05) per year), normal haemoglobin (1.85 (1.16 to 2.95) vs low haemoglobin), active lupus (British Isles Lupus Assessment Group A or B) in haematological and mucocutaneous domains (0.61 (0.39 to 0.97) and 0.50 (0.31 to 0.81)), baseline damage (SDI>1 vs =0) (0.38 (0.16 to 0.91)) and 24-hour urine protein (0.63 (0.50 to 0.80)). LN duration 2–4 years (0.43 (0.19 to 0.97) vs <1 year) and 24-hour urine protein (0.63 (0.45 to 0.89)) were negative predictors of CRR. LN duration 2–4 years (0.45 (0.24 to 0.83) vs <1 year) negatively predicted PRR. The AUROCs of models for improvement, CRR and PRR were 0.56, 0.55 and 0.51 respectively. Conclusions: Baseline variables predicted 6-month outcomes in patients with SLE. While the modest performance of models emphasises the need for new biomarkers to advance this field, the factors identified can help identify those patients who may require novel treatment strategies.