Dialogue: Early predictors of long-term lupus nephritis outcomes: looking into the future

Patients with lupus nephritis (LN) remain difficult to treat, and any patient characteristics that allow physicians to better predict outcomes are likely to improve patient care. Clinical and serological factors that present early in the course of treatment can predict long-term outcomes, and are, therefore, important to identify. The current study by Dall'Era et al 1 adds to a growing literature regarding the early predictors of long-term outcomes in patients with LN. The study analysed data from Aspreva Lupus Management Study (ALMS) extending to 36 months post induction to assess those factors determining either complete renal remission (CR) or treatment failure (TF). They assess features at the time of trial entry and end of induction, and response to therapy during induction. Complete response could occur at any time during the maintenance phase. Among the 370 subjects who entered the trial, only non-Hispanic ethnicity was associated with a higher likelihood of CR. Several factors related to induction were independently associated with a greater likelihood of TF, including the positive anti-dsDNA at trial entry, failure to reduce anti-dsDNA within 8 weeks, failure to reduce urine protein:creatinine ratio (UP/C) by >25% within 8 weeks. Among the 227 subjects who entered …