title: Long-term follow-up of the MAINTAIN Nephritis Trial, comparing azathioprine and mycophenolate mofetil as maintenance therapy of lupus nephritis.
abstract: OBJECTIVE
  To report the 10-year follow-up of the MAINTAIN Nephritis Trial comparing azathioprine (AZA) and mycophenolate mofetil (MMF) as maintenance therapy of proliferative lupus nephritis, and to test different definitions of early response as predictors of long-term renal outcome.
  
  
  METHODS
  In 2014, data on survival, kidney function, 24 h proteinuria, renal flares and other outcomes were collected for the 105 patients randomised between 2002 and 2006, except in 13 lost to follow-up.
  
  
  RESULTS
  Death (2 and 3 in the AZA and MMF groups, respectively) and end-stage renal disease (1 and 3, respectively) were rare events. Time to renal flare (22 and 19 flares in AZA and MMF groups, respectively) did not differ between AZA and MMF patients. Patients with good long-term renal outcome had a much more stringent early decrease of 24 h proteinuria compared with patients with poor outcome. The positive predictive value of a 24 h proteinuria <0.5 g/day at 3 months, 6 months and 12 months for a good long-term renal outcome was excellent (between 89% and 92%). Inclusion of renal function and urinalysis in the early response criteria did not impact the value of early proteinuria decrease as long-term prognostic marker.
  
  
  CONCLUSIONS
  The long-term follow-up data of the MAINTAIN Nephritis Trial do not indicate that MMF is superior to AZA as maintenance therapy in a Caucasian population suffering from proliferative lupus nephritis. Moreover, we confirm the excellent positive predictive value of an early proteinuria decrease for long-term renal outcome.
  
  
  BACKGROUND
  NCT00204022.
authors.affiliation: Rheumatology Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Farah
authors.initials: F
authors.lastname: Tamirou
authors.affiliation: Louise Coote Lupus Unit, St Thomas' Hospital, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: D'Cruz
authors.affiliation: Louise Coote Lupus Unit, St Thomas' Hospital, London, UK.
authors.forename: Shirish
authors.initials: S
authors.lastname: Sangle
authors.affiliation: Nephrology Department, Hôpital Henri Mondor, Créteil, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Remy
authors.affiliation: Clinical Immunology Unit, Hospital Santo Antonio, ICBAS, Porto, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Vasconcelos
authors.affiliation: ACURA Center for Rheumatic Diseases, Baden-Baden, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Fiehn
authors.affiliation: Department of General Internal Medicine, Hospital Regional Universitario Carlos Haya, Malaga, Spain.
authors.forename: Maria del Mar
authors.initials: Mdel M
authors.lastname: Ayala Guttierez
authors.affiliation: Rheumatology Department, Rikshospitalet University Hospital, Oslo, Norway.
authors.forename: Inge-Magrethe
authors.initials: IM
authors.lastname: Gilboe
authors.affiliation: First Department of Internal Medicine, National University of Athens, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Tektonidou
authors.affiliation: General Internal Medicine Department, UZ Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Daniel
authors.initials: D
authors.lastname: Blockmans
authors.affiliation: Rheumatology Department, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Ravelingien
authors.affiliation: General Internal Medicine Department, Hôpital Cochin, Paris, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: le Guern
authors.affiliation: Rheumatology Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Depresseux
authors.affiliation: General Internal Medicine Department, Hôpital Cochin, Paris, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Guillevin
authors.affiliation: Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Cervera
authors.affiliation: Rheumatology Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Frédéric A
authors.initials: FA
authors.lastname: Houssiau
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic; D008137:Longitudinal Studies; D008181:Lupus Nephritis / Q000188:drug therapy*; D060046:Maintenance Chemotherapy; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011507:Proteinuria; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D001379:Azathioprine
keywords: Lupus Nephritis; Outcomes research; Treatment