Division of Rheumatology, UCS F , San Francisco, California , USA.
Vifor Pharma , Victoria, British Columbia , Canada.
Lupus Sci Med. 2015 May 20;2(1):e000089. doi: 10.1136/lupus-2015-000089. eCollection 2015.
To identify factors associated with clinical outcome in patients with lupus nephritis.
Data from the Aspreva Lupus Management Study (ALMS) were analysed. Using multivariate analysis, we assessed the prognostic value of demographic, clinical, laboratory and histopathological features on the frequency of either complete remission (CR) or treatment failure (TF) during the maintenance phase.
Among the 370 subjects who entered the trial (complete population), non-Hispanic ethnicity was associated with a higher likelihood of CR (OR=2.0). Several factors were independently associated with a greater likelihood of TF, including: (1) anti-double-stranded DNA (anti-dsDNA) at trial entry (OR=12.7), (2) failure to reduce anti-dsDNA within 8 weeks (OR=2.9) and (3) failure to reduce urine protein:creatinine ratio (UP/C) by ≥25% within 8 weeks (OR=2.6). Among the 227 subjects who entered the maintenance phase (maintenance population), baseline estimated glomerular filtration rate (eGFR) ≥90 mL/min/1.73 m(2) was associated with a greater likelihood of CR (OR=2.0), and UP/C >1 at the end of induction was associated with a lower likelihood of CR (OR=0.3). Induction treatment with intravenous cyclophosphamide (IVC) was associated with a lower likelihood of TF (OR=0.5), while lack of treatment with antimalarials (OR=2.4), failure to reduce anti-dsDNA during the first 8 weeks of induction (OR=3.5), failure to reduce UP/C during the first 8 weeks of induction (OR=2.1) and anti-dsDNA positivity at the end of induction (OR=8.3) were independently associated with a greater likelihood of TF.
This analysis demonstrates that levels of anti-dsDNA and UP/C during induction treatment are independently associated with renal outcome over the ensuing 3 years in both the complete and maintenance populations. Ethnicity is associated with renal outcome in just the complete population, and eGFR, induction treatment and treatment with antimalarials are associated with renal outcome in just the maintenance population.
确定狼疮肾炎患者临床结局的相关因素。
对 Aspreva 狼疮管理研究（ALMS）的数据进行分析。采用多变量分析，我们评估了人口统计学、临床、实验室和组织病理学特征对维持期完全缓解（CR）或治疗失败（TF）频率的预后价值。
在进入试验的 370 名受试者（完整人群）中，非西班牙裔种族与更高的 CR 可能性相关（OR=2.0）。一些因素与更大的 TF 可能性独立相关，包括：（1）试验时抗双链 DNA（anti-dsDNA）阳性（OR=12.7），（2）8 周内未能降低抗 dsDNA（OR=2.9），（3）8 周内未能降低尿蛋白/肌酐比值（UP/C）≥25%（OR=2.6）。在进入维持期的 227 名受试者（维持人群）中，基线估计肾小球滤过率（eGFR）≥90mL/min/1.73m2与更高的 CR 可能性相关（OR=2.0），诱导结束时 UP/C＞1 与更低的 CR 可能性相关（OR=0.3）。诱导治疗中使用静脉注射环磷酰胺（IVC）与更低的 TF 可能性相关（OR=0.5），而缺乏抗疟药物治疗（OR=2.4）、诱导期前 8 周内未能降低抗 dsDNA（OR=3.5）、诱导期前 8 周内未能降低 UP/C（OR=2.1）和诱导期末抗 dsDNA 阳性（OR=8.3）与更高的 TF 可能性独立相关。
本分析表明，诱导治疗期间抗 dsDNA 和 UP/C 的水平与完整和维持人群中接下来 3 年的肾脏结局独立相关。种族仅与完整人群的肾脏结局相关，eGFR、诱导治疗和抗疟药物治疗仅与维持人群的肾脏结局相关。
