2082 The Journal of Rheumatology 2015; 42:11; doi:10.3899/jrheum.150395 Personal non-commercial use only. The Journal of Rheumatology Copyright © 2015. All rights reserved. Comparison of Lupus Nephritis Induction Treatments in a Hispanic Population: A Single-center Cohort Analysis Juan Manuel Mejía-Vilet, José Manuel Arreola-Guerra, Bertha M. Córdova-Sánchez, Luis Eduardo Morales-Buenrostro, Norma O. Uribe-Uribe, and Ricardo Correa-Rotter ABSTRACT. Objective. To evaluate response rates in an adult lupus nephritis (LN) cohort in Mexico City, Mexico. Methods. We analyzed 165 patients with biopsy-proven LN histological International Society of Nephrology/Renal Pathology Society classes III, IV, or V, distributed by treatment drug in 3 groups: mycophenolate mofetil (MMF; dosage > 2 g/day per 6 mos, n = 63), intravenous cyclophosphamide (IVC; 0.7 g/m 2 body surface area monthly per 6 pulses, n = 66), or azathioprine (AZA; dosage > 1.5 mg/kg/day per 6 mos, n = 36). Median followup was 31 ± 18 months. The primary endpoint was the proportion of patients achieving complete renal response (CR). Secondary endpoints included the proportion of patients achieving renal response (complete or partial), renal flare–free survival, doubling of serum creatinine, and progression to endstage renal disease (ESRD). Results. MMF induction was superior to IVC (HR 2.00, 95% CI 1.23–3.25, p = 0.005) and AZA (HR 2.12, 95% CI 1.23–3.66, p = 0.007) in the primary endpoint. Censored CR rates at 6, 12, 24, and 36 months were 32.6%, 56.1%, 76.6%, and 94.1% for MMF; 24.2%, 34.4%, 57.9%, and 62.1% for IVC; and 8.4%, 39.8%, 49.7%, and 49.7% for AZA. MMF was also superior in renal response to treatment and renal flare–free survival outcomes. There were no differences between groups in doubling of serum creatinine or progression to ESRD. The induction treatment with MMF (HR 2.04, 95% CI 1.25–3.33, p = 0.005) and absence of vascular lesions on renal biopsy (HR 2.05, 95% CI 1.25–3.37, p = 0.004) were associated with CR, whereas proteinuria at the time of presentation was negatively associated with CR (HR 0.91, 95% CI 0.84–0.98, p = 0.013). Conclusion. MMF induction therapy is superior to IVC and AZA in patients with LN of Mexican-mestizo race. (First Release September 15 2015; J Rheumatol 2015;42:2082–91; doi:10.3899/jrheum.150395) Key Indexing Terms: LUPUS NEPHRITIS CYCLOPHOSPHAMIDE MYCOPHENOLATE MOFETIL AZATHIOPRINE MEXICAN-MESTIZO HISPANIC From the Department of Nephrology and Mineral Metabolism, and Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. The project was performed with the financial and human resources of the Department of Nephrology and Mineral Metabolism of the institute. J.M. Mejía-Vilet, MD, Attending Physician, Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J.M. Arreola-Guerra, MD, Attending Physician, Department of Internal Medicine, and Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; B.M. Córdova-Sánchez, MD, Nephrology Fellow, Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; L.E. Morales-Buenrostro, MD, PhD, Research Scientist, Attending Physician, Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; N.O. Uribe-Uribe, MD, Pathologist, Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; R. Correa-Rotter, MD, Head of Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Address correspondence to Dr. R. Correa-Rotter, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Nephrology and Mineral Metabolism, Vasco de Quiroga 15, Mexico City, DF 14000, Mexico. E-mail: correarotter@gmail.com Accepted for publication July 1, 2015. Lupus nephritis (LN) is present in almost 50% of patients with systemic lupus erythematosus (SLE) 1 . It is one of the main mortality predictors 2 , and its remission significantly improves patient and renal survival 3 . Even with present thera- peutic regimens, almost 10% to 20% of patients will eventually develop endstage renal disease (ESRD) 4 . It has been clearly demonstrated that Hispanic populations have an early onset of renal disease 5 and worse survival 6 ; the latter has been attributed to lower socioeconomic conditions 7 . Current induction to remission therapeutic regimens for LN include a combination of immunosuppressive agents: mycophenolate mofetil (MMF), intravenous cyclophos- phamide (IVC), azathioprine (AZA), and steroids 8 . The Aspreva Lupus Management Study (ALMS) suggested that Hispanic populations might benefit from the induction of MMF as compared with IVC 9 . In our present study, we retrospectively compared efficacy of LN induction with remission treatment regimens containing IVC, MMF, or AZA in a single-center cohort of patients with LN. www.jrheum.org Downloaded on November 28, 2021 from