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Comparative Effectiveness of Mycophenolate Mofetil for the Treatment of Juvenile‐Onset Proliferative Lupus Nephritis
Author(s) -
Tian Simon Y.,
Silverman Earl D.,
Pullenayegum Eleanor,
Brown Patrick E.,
Beyene Joseph,
Feldman Brian M.
Publication year - 2017
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23215
Subject(s) - medicine , lupus nephritis , confounding , renal function , confidence interval , cohort , marginal structural model , juvenile , cohort study , prospective cohort study , disease , biology , genetics
Objective Although juvenile‐onset proliferative lupus nephritis ( PLN ) leads to significant morbidity and mortality, there is no clinical trials–based evidence to support the treatment effectiveness of any therapy for juvenile‐onset PLN . Marginal structural models enable us to estimate treatment effectiveness using observational data while accounting for confounding by indication. Methods We used prospectively collected data to examine the effect of mycophenolate mofetil ( MMF ), compared to the use of other therapies, on the long‐term outcome of a juvenile‐onset PLN cohort (age at PLN onset <18 years). The major outcome variable was the estimated glomerular filtration rate ( GFR ) using the revised Schwartz formula. Confounding by indication was corrected for marginal structural model. Results A total of 172 subjects with juvenile‐onset PLN , with a mean followup duration of approximately 4 years, were included. Overall, MMF was superior to other therapies, with a relative effect estimate for MMF of 1.06, i.e., 6% better estimated GFR on average (95% confidence interval 0.7, 11.3), corrected for potential confounding by indication. We found that beginning in year 4 there was a significant improvement in estimated GFR in the patients who were treated with MMF versus other therapies. This improvement was maintained until the end of the study. Conclusion MMF was more beneficial than other therapies in improving/maintaining long‐term renal function in patients with juvenile‐onset PLN up to a maximum followup of 7 years. This finding is consistent with evidence from adult PLN clinical trials.