ALMS
Aspreva Lupus Management Study
Patient / Population Intervention / Exposure Comparison Outcome
In 370 patients with active lupus nephritis, mycophenolate mofetil was non-inferior for induction response and superior for maintenance versus cyclophosphamide then azathioprine.
N
370
Design
Open-label RCT (induction and maintenance phases)
Endpoint
Treatment response at 24 weeks; time to treatment failure
Relevance
2
ResultInduction response 56.2% MMF vs 53.0% IV cyclophosphamide; maintenance MMF vs azathioprine HR 0.44 for failure (p<0.001).
Appel GB, et al. J Am Soc Nephrol. 2009;20(5):1103-1112. 10.1681/ASN.2008101028
Discussion & critique
Made MMF an equivalent induction and superior maintenance agent; KDIGO 2024 prefers MMF with low-dose steroids.