Lupus & antiphospholipid syndrome
Performance of Modified ALMS and BLISS Criteria with Standard of Care Treatment in Two US Health Care Systems
Authors' conclusion
In a primarily Black, uninsured LN population, despite achieving similar CR rates at 12 months, the incidence of ESRD and death exceeded those observed in controlled clinical trials with placebo arms.
Study context
- Population
- Predominantly Black patients with biopsy-proven lupus nephritis (LN) class III or IV ± V, urine protein-to-creatinine ratio ≥1gm/gm and eGFR >50 ml/minute/1.73 m² at incident LN flare, undergoing standard treatment77.5% Black
- Participants
- 173 patients
- Outcome
- Incidence of, and risk factors for, CR by mALMS and mBLISS criteria
- Follow-up
- 12 months
Methodological detailsmultivariable Cox regression, two US health care systems
- Multivariable Cox regression
- Two US health care systems
Main finding
As reported in the abstract
CR by 12 months
Modified Aspreva Lupus Management Study (mALMS) complete response (CR)
20.6%
95% CI 14.6–28.6%
mBLISS CR
33.7%
95% CI 26.4–42.4%
Observational data: associations, not effects.
Further findings
Factors associated with mBLISS CR
| Adjusted CR ratio | P value | |
|---|---|---|
| Commercial insurance | 3.5 (95% CI 1.9–6.7) | P < 0.001 |
| Albumin, per 1 gm/dl increase | 1.8 | P = 0.02 |
| Low C4 | 2.6 | P = 0.03 |
Cumulative incidence of end-stage renal disease (ESRD) and death · 3 years
- ESRD
- 23.1% (95% CI 15.7-31.3%)
- Death
- 6.1% (95% CI 2.8-11.1%)
Cumulative incidence of ESRD by insurance · 3 years
- Non-commercial insurance
- 30.4% (95% CI 19.6-41.9%)
- Commercial insurance
- 12.7% (95% CI 5.0-24.2%)
- Non-commercial vs commercial
- P = 0.024
Original publication
Performance of Modified ALMS and BLISS Criteria with Standard of Care Treatment in Two US Health Care Systems. Arthritis Care Res (Hoboken). Published 31 January 2023. doi:10.
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