Evidence map›Paper›PMID 25757867›Full record

Trial reportAnnals of the rheumatic diseases2016

Long-term follow-up of the MAINTAIN Nephritis Trial, comparing azathioprine and mycophenolate mofetil as maintenance therapy of lupus nephritis.

Farah Tamirou, David D'Cruz, Shirish Sangle, Philippe Remy, Carlos Vasconcelos, Christoph Fiehn, Maria del Mar Ayala Guttierez, Inge-Magrethe Gilboe, Maria Tektonidou, Daniel Blockmans and 7 more

Registry-linked trialAbstract readComparative StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Annals of the rheumatic diseases, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00204022 (A Randomized Multicenter Trial Comparing Mycophenolate Mofetil and Azathioprine as Remission-maintaining Treatment for Proliferative Lupus Glomerulonephritis. The MAINTAIN Nephritis Trial.), which is not on this map. Cited by 88 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
88citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00204022 phase3completednot on this map

A Randomized Multicenter Trial Comparing Mycophenolate Mofetil and Azathioprine as Remission-maintaining Treatment for Proliferative Lupus Glomerulonephritis. The MAINTAIN Nephritis Trial.

TypeinterventionalSponsorFrédéric A. Houssiau, MD, PhDRan2001 to 2011Enrolled105ConditionsLupus NephritisArmsMycophenolate mofetil, Azathioprine
3 · Its place in the literature

Who cites it

88 citing papers in PubMed, 6 syntheses or guidelines pooled it.

  1. Guideline
  2. Guideline
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Immunosuppressive treatment for proliferative lupus nephritis.The Cochrane database of systematic reviews · 2018
    Pooled it
  7. Trial
  8. Trial
  9. Trial
  10. Review
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Review
  17. Article
  18. Article
  19. Article
  20. Lupus nephritis.Nature reviews. Disease primers · 2025
    Review

28 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors.

Farah TamirouRheumatology Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
David D'CruzLouise Coote Lupus Unit, St Thomas' Hospital, London, UK.
Shirish SangleLouise Coote Lupus Unit, St Thomas' Hospital, London, UK.
Philippe RemyNephrology Department, Hôpital Henri Mondor, Créteil, France.
Carlos VasconcelosClinical Immunology Unit, Hospital Santo Antonio, ICBAS, Porto, Portugal.
Christoph FiehnACURA Center for Rheumatic Diseases, Baden-Baden, Germany.
Maria del Mar Ayala GuttierezDepartment of General Internal Medicine, Hospital Regional Universitario Carlos Haya, Malaga, Spain.
Inge-Magrethe GilboeRheumatology Department, Rikshospitalet University Hospital, Oslo, Norway.
Maria TektonidouFirst Department of Internal Medicine, National University of Athens, Athens, Greece.
Daniel BlockmansGeneral Internal Medicine Department, UZ Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
Isabelle RavelingienRheumatology Department, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium.
Véronique le GuernGeneral Internal Medicine Department, Hôpital Cochin, Paris, France.
Geneviève DepresseuxRheumatology Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
Loïc GuillevinGeneral Internal Medicine Department, Hôpital Cochin, Paris, France.
Ricard CerveraDepartment of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain.
Frédéric A HoussiauRheumatology Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
MAINTAIN Nephritis Trial Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo report the 10-year follow-up of the MAINTAIN Nephritis Trial comparing azathioprine (AZA) and mycophenolate mofetil (MMF) as maintenance therapy of proliferative lupus nephritis, and to test different definitions of early response as predictors of long-term renal outcome.

methodsIn 2014, data on survival, kidney function, 24 h proteinuria, renal flares and other outcomes were collected for the 105 patients randomised between 2002 and 2006, except in 13 lost to follow-up.

resultsDeath (2 and 3 in the AZA and MMF groups, respectively) and end-stage renal disease (1 and 3, respectively) were rare events. Time to renal flare (22 and 19 flares in AZA and MMF groups, respectively) did not differ between AZA and MMF patients. Patients with good long-term renal outcome had a much more stringent early decrease of 24 h proteinuria compared with patients with poor outcome. The positive predictive value of a 24 h proteinuria <0.5 g/day at 3 months, 6 months and 12 months for a good long-term renal outcome was excellent (between 89% and 92%). Inclusion of renal function and urinalysis in the early response criteria did not impact the value of early proteinuria decrease as long-term prognostic marker.

conclusionsThe long-term follow-up data of the MAINTAIN Nephritis Trial do not indicate that MMF is superior to AZA as maintenance therapy in a Caucasian population suffering from proliferative lupus nephritis. Moreover, we confirm the excellent positive predictive value of an early proteinuria decrease for long-term renal outcome. TRIAL REGISTRATION NUMBER: NCT00204022.

Indexed as

AdultAzathioprineDisease ProgressionFemaleFollow-Up StudiesHumansImmunosuppressive AgentsKidney Failure, ChronicLongitudinal StudiesLupus NephritisMaintenance ChemotherapyMaleMiddle AgedMycophenolic AcidProteinuriaTreatment OutcomeAzathioprineImmunosuppressive AgentsMycophenolic AcidLupus NephritisOutcomes researchTreatment

Identifiers

PMID25757867
PMCPMC4789692

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.