title: Comparison of Lupus Nephritis Induction Treatments in a Hispanic Population: A Single-center Cohort Analysis.
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).
  
  
  CONCLUSIONS
  MMF induction therapy is superior to IVC and AZA in patients with LN of Mexican-mestizo race.
authors.affiliation: From the Department of Nephrology and Mineral Metabolism, and Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.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.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Mejía-Vilet
authors.affiliation: From the Department of Nephrology and Mineral Metabolism, and Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.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.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Arreola-Guerra
authors.affiliation: From the Department of Nephrology and Mineral Metabolism, and Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.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.
authors.forename: Bertha M
authors.initials: BM
authors.lastname: Córdova-Sánchez
authors.affiliation: From the Department of Nephrology and Mineral Metabolism, and Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.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.
authors.forename: Luis Eduardo
authors.initials: LE
authors.lastname: Morales-Buenrostro
authors.affiliation: From the Department of Nephrology and Mineral Metabolism, and Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.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.
authors.forename: Norma O
authors.initials: NO
authors.lastname: Uribe-Uribe
authors.affiliation: From the Department of Nephrology and Mineral Metabolism, and Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.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. correarotter@gmail.com.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Correa-Rotter
mesh_terms: D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000704:Analysis of Variance; D001379:Azathioprine / Q000627:therapeutic use*; D001707:Biopsy, Needle; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006784:Hospitals, Teaching; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D053208:Kaplan-Meier Estimate; D007677:Kidney Function Tests; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008800:Mexico; D015999:Multivariate Analysis; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012074:Remission Induction; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D009173:Mycophenolic Acid; D001379:Azathioprine
keywords: AZATHIOPRINE; CYCLOPHOSPHAMIDE; HISPANIC; LUPUS NEPHRITIS; MEXICAN-MESTIZO; MYCOPHENOLATE MOFETIL