Patient preferences for treatment of lupus nephritis

Authors

  • Liana Fraenkel,

    Corresponding author
    1. Yale University, New Haven, Connecticut and Veterans Administration Connecticut Healthcare System, West Haven, Connecticut
    • Section of Rheumatology, Department of Internal Medicine, Yale University, 333 Cedar Street, New Haven, CT 06520-8031
    Search for more papers by this author
    • Dr. Fraenkel's work was supported by a Veterans Administration Career Development Award and an Arthritis Investigator Award from the Arthritis Foundation.

  • Sidney Bogardus,

    1. Yale University, New Haven, Connecticut
    Search for more papers by this author
    • Dr. Bogardus's work was supported by a Pfizer American Geriatrics Society Postdoctoral Fellowship for Research on Health Outcomes in Geriatrics.

  • John Concato

    1. Yale University, New Haven, Connecticut and Veterans Administration Connecticut Healthcare System, West Haven, Connecticut
    Search for more papers by this author

Abstract

Objective

To examine the amount of improvement in renal survival that lupus patients require before choosing cyclophosphamide over azathioprine for the treatment of lupus nephritis.

Methods

Patients were presented with descriptions of cyclophosphamide and azathioprine and asked to indicate their preferred choice if each conferred an equal probability of renal survival. Strength of preference was assessed by systematically increasing the probability of renal survival of the more toxic treatment until the respondent's choice switched.

Results

Ninety-three well-educated women (mean age ± SD 40 ± 7 years) participated in the study. Ninety-eight percent (91/93) of the participants chose azathioprine over cyclophosphamide when both drugs conferred an equal probability of renal survival. Although most subjects switched preferences to cyclophosphamide for better renal survival, 31% (28/91) were unwilling to switch from azathioprine to cyclophosphamide for improved short-term renal survival, and 15% (14/91) were unwilling to switch from azathioprine to cyclophosphamide for improved long-term renal survival.

Conclusion

Although the majority of patients switched preferences to cyclophosphamide for better renal survival, a substantial minority was unwilling to accept the toxicity associated with cyclophosphamide, even if it was much better than azathioprine at preventing renal failure.

Ancillary