Abatacept for lupus nephritis: alternative definitions of complete response
support conflicting conclusions.
Author(s): Wofsy D, Hillson JL, Diamond B.
Affiliation(s): University of California, San Francisco, USA. wofsyd@medsch.ucsf.edu
Publication date & source: 2012, Arthritis Rheum. , 64(11):3660-5
OBJECTIVE: Recent clinical trials in lupus nephritis have all used different
criteria to assess complete response. The objective of this analysis was to
compare several previously proposed criteria, using the same data set from a
large trial of abatacept in lupus nephritis (IM101075). In so doing, we sought to
determine which criteria are most sensitive to differences among treatment groups
and to further examine the potential of abatacept in lupus nephritis.
METHODS: Patients in the IM101075 trial received abatacept at 1 of 2 different
dose regimens or placebo, both on a background of mycophenolate mofetil and
corticosteroids. Using data from this trial, we assessed rates of complete
response at 12 months according to 5 sets of criteria, from 1) the trial
protocol, 2) the Aspreva Lupus Management Study (ALMS) trial of mycophenolate
mofetil, 3) the Lupus Nephritis Assessment with Rituximab (LUNAR) trial of
rituximab, 4) an ongoing National Institutes of Health trial of abatacept
(Abatacept and Cyclophosphamide Combination: Efficacy and Safety Study [ACCESS]),
and 5) published recommendations of the American College of Rheumatology.
RESULTS: According to the complete response definition from the IM101075 study
protocol, there was no difference among treatment groups in the IM101075 study.
In contrast, according to the ALMS, LUNAR, and ACCESS criteria, rates of complete
response among patients in the IM101075 study were higher in both treatment
groups relative to control. The largest differences were obtained with use of the
LUNAR criteria (complete response rate of 6% in the control group, compared to
22% and 24% in the 2 abatacept groups).
CONCLUSION: The choice of definition of complete response can determine whether a
lupus nephritis trial is interpreted as a success or a failure. The results of
this analysis provide an evidence-based rationale for choosing among alternative
definitions and offer a strong rationale for conducting further studies of
abatacept in lupus nephritis.
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