Comparison of standard of care treatment with a low steroid and mycophenolate mofetil regimen for lupus nephritis in the ALMS and AURA studies.

Abstract	Lupus nephritis is the most common organ-threatening manifestation of systemic lupus erythematosus. The current standard of care for patients is treatment with a combination of steroids plus either mycophenolate mofetil (MMF) or cyclophosphamide. However, these medications are associated with considerable toxicity and suboptimal efficacy. This retrospective propensity analysis of data from 63 matched patients enrolled in two of the largest active lupus nephritis controlled trials, ALMS and AURA, suggests that the high dose regimen of MMF and steroids as described in the 2012 American College of Rheumatology lupus nephritis guidelines may not be necessary in all lupus nephritis patients. A lower dose regimen may result in better long-term safety, including a reduction in lymphoproliferative disorders, skin cancers and steroid related side effects, without compromising efficacy. An ongoing randomized controlled double-blind phase 3 study, AURORA (NCT03021499), is investigating renal response in 358 patients randomized to receive a low dose regimen containing voclosporin, MMF and steroid therapy as used in the AURA trial. It is anticipated that the AURORA study and its blinded two-year extension will provide important long-term outcome data.
Authors	M Dall'Era, N Solomons, R Federico, M Truman
Journal	Lupus (Lupus) Vol. 28 Issue 5 Pg. 591-596 (Apr 2019) ISSN: 1477-0962 [Electronic] England
PMID	31066646 (Publication Type: Comparative Study, Journal Article)
Chemical References	Immunosuppressive Agents Steroids voclosporin Cyclosporine Cyclophosphamide Mycophenolic Acid
Topics	Adolescent Adult Aged Cyclophosphamide (therapeutic use) Cyclosporine (therapeutic use) Dose-Response Relationship, Drug Drug Administration Schedule Drug Therapy, Combination Female Humans Immunosuppressive Agents (therapeutic use) Logistic Models Lupus Nephritis (drug therapy, pathology) Male Middle Aged Mycophenolic Acid (therapeutic use) Propensity Score Randomized Controlled Trials as Topic Remission Induction Retrospective Studies Standard of Care Steroids (therapeutic use) Time-to-Treatment Treatment Outcome Young Adult

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