Imperial College London
Alternate

PROFESSOR H. TERENCE COOK

Faculty of Medicine, Department of Immunology and Inflammation

Emeritus Professor
 
 
 
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Contact

 

+44 (0)20 3313 2009t.h.cook

 
 
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Assistant

 

Miss Claudia Rocchi +44 (0)20 3313 2315

 
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Location

 

9N9Commonwealth BuildingHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Barbour:2020:10.1016/j.kint.2020.04.042,
author = {Barbour, SJ and Canney, M and Coppo, R and Zhang, H and Liu, Z-H and Suzuki, Y and Matsuzaki, K and Katafuchi, R and Induruwage, D and Er, L and Reich, HN and Feehally, J and Barratt, J and Cattran, DC and International, IgA Nephropathy Network},
doi = {10.1016/j.kint.2020.04.042},
journal = {Kidney Int},
pages = {1009--1019},
title = {Improving treatment decisions using personalized risk assessment from the International IgA Nephropathy Prediction Tool.},
url = {http://dx.doi.org/10.1016/j.kint.2020.04.042},
volume = {98},
year = {2020}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Immunosuppression in IgA nephropathy (IgAN) should be reserved for patients at high-risk of disease progression, which KDIGO guidelines determine based solely on proteinuria 1g or more/day. To investigate if treatment decisions can be more accurately accomplished using individualized risk from the International IgAN Prediction Tool, we simulated allocation of a hypothetical immunosuppression therapy in an international cohort of adults with IgAN. Two decision rules for treatment were applied based on proteinuria of 1g or more/day or predicted risk from the Prediction Tool above a threshold probability. An appropriate decision was defined as immunosuppression allocated to patients experiencing the primary outcome (50% decline in eGFR or ESKD) and withheld otherwise. The net benefit and net reduction in treatment are the proportion of patients appropriately allocated to receive or withhold immunosuppression, adjusted for the harm from inappropriate decisions, calculated for all threshold probabilities from 0-100%. Of 3299 patients followed for 5.1 years, 522 (15.8%) experienced the primary outcome. Treatment allocation based solely on proteinuria of 1g or more/day had a negative net benefit (was harmful) because immunosuppression was increasingly allocated to patients without progressive disease. Compared to using proteinuria, treatment allocation using the Prediction Tool had a larger net benefit up to 23.4% (95% confidence interval 21.5-25.2%) and a larger net reduction in treatment up to 35.1% (32.3-37.8%). Thus, allocation of immunosuppression to high-risk patients with IgAN can be substantially improved using the Prediction Tool compared to using proteinuria.
AU  - Barbour,SJ
AU  - Canney,M
AU  - Coppo,R
AU  - Zhang,H
AU  - Liu,Z-H
AU  - Suzuki,Y
AU  - Matsuzaki,K
AU  - Katafuchi,R
AU  - Induruwage,D
AU  - Er,L
AU  - Reich,HN
AU  - Feehally,J
AU  - Barratt,J
AU  - Cattran,DC
AU  - International,IgA Nephropathy Network
DO  - 10.1016/j.kint.2020.04.042
EP  - 1019
PY  - 2020///
SP  - 1009
TI  - Improving treatment decisions using personalized risk assessment from the International IgA Nephropathy Prediction Tool.
T2  - Kidney Int
UR  - http://dx.doi.org/10.1016/j.kint.2020.04.042
UR  - https://www.ncbi.nlm.nih.gov/pubmed/32464215
VL  - 98
ER  -
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