title: Geographical variation in the response of lupus nephritis to mycophenolate mofetil induction therapy.
abstract: OBJECTIVE
  The induction therapy used in the management of Class III and IV lupus nephritis has been narrowed down to a choice between cyclophosphamide (CYC) and mycophenolate mofetil (MMF). However, there has been variability in the response to these agents, which may relate to demographic factors. In this study, we analyzed geographic factors affecting the response to CYC or MMF with a stratified meta-analysis.
  
  
  METHODS
  We found and included 11 studies for our analyses--7 randomized controlled trials (RCTs) and 4 non-RCTs--that were stratified as being in Asia or elsewhere.
  
  
  RESULTS
  Meta-analysis of Asian studies showed no difference between regimens (RR = 0.98, 95% CI 0.74-1.28, p = ns) and no heterogeneity. The 2 RCT's from outside Asia showed significant advantage of MMF as induction therapy (RR = 3.69, 95%CI 1.45-9.3, p < 0.01) without heterogeneity. Together there was significant heterogeneity (Q = 11.69, I2 = 57.2%, p < 0.05) suggesting that the overall heterogeneity results from a difference between these groups. We repeated this analysis with the multicenter ALMS trial with their reported ethnicity-specific data. Again, no significant heterogeneity was seen in either subgroup (Asian: Q = 2.08, I2 = 0%, p = ns; Others: Q = 4.49, I2 = 55.5%, p = ns). Studies from Asia did not show a significant improvement with the use of MMF (RR = 1.06, 95%CI 0.79-1.41, p = ns) while data from RCTs conducted outside Asia suggested a greater likelihood of complete remission with the use of MMF (RR = 1.85, 95%CI 1.03-3.29, p < 0.05).
  
  
  CONCLUSIONS
  Our analysis demonstrates a higher likelihood of complete remission with MMF in patients outside Asia.
authors.affiliation: Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. sm2206@columbia.edu
authors.forename: S
authors.initials: S
authors.lastname: Mohan
authors.forename: J
authors.initials: J
authors.lastname: Radhakrishnan
mesh_terms: D044466:Asian People / Q000706:statistics & numerical data; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000208:ethnology; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D044469:Racial Groups / Q000706:statistics & numerical data*; D012074:Remission Induction; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D009173:Mycophenolic Acid