Predictors of treatment response in a lupus nephritis population: lessons from the Aspreva Lupus Management Study (ALMS) trial.
Authors
Yiu, Sean
Su, Li
Gordon, Caroline
Truman, Matt
Lisk, Laura
Solomons, Neil
MASTERPLANS Consortium
Publication Date
2022-05Journal Title
Lupus Sci Med
ISSN
2053-8790
Publisher
BMJ
Volume
9
Issue
1
Language
en
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
McDonald, S., Yiu, S., Su, L., Gordon, C., Truman, M., Lisk, L., Solomons, N., et al. (2022). Predictors of treatment response in a lupus nephritis population: lessons from the Aspreva Lupus Management Study (ALMS) trial.. Lupus Sci Med, 9 (1) https://doi.org/10.1136/lupus-2021-000584
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.
Keywords
cyclophosphamide, lupus nephritis, treatment, Cohort Studies, Hemoglobins, Humans, Kidney, Lupus Erythematosus, Systemic, Lupus Nephritis
Identifiers
lupus-2021-000584
External DOI: https://doi.org/10.1136/lupus-2021-000584
This record's URL: https://www.repository.cam.ac.uk/handle/1810/337855
Rights
Licence:
https://creativecommons.org/licenses/by/4.0/
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