Efficacy of long-term maintenance therapy with mycophenolate mofetil in lupus nephritis

Abstract

BackgroundMycophenolate mofetil (MMF) has long been used to manage lupus nephritis. Despite research on its long-term efficacy, it is still warranted to conduct further investigation regarding its indications, safety and outcome. This study was intended to evaluate our proposed protocol in maintenance therapy with MMF.Twenty-four lupus nephritis patients were registered prior to their receiving 3–6 month induction therapy with monthly iv pulses of cyclophosphamide (CYC), followed by 24 month maintenance therapy using MMF and steroid. We defined end points as achievement of complete and partial remission, relapse, refractory to therapy as well as end stage renal disease (ESRD) and death. Friedman and repeated measurement tests were used to assess the effect of treatment on parameters over time.Complete renal remission was achieved in 79.16% until the end of the last follow up with an average period of 12.45 ± 7.37 months since treatment commenced. Significant statistical differences were seen regarding proteinuria, hematuria, leukocyturia, plasma creatinine, C3, C4 before and after therapy (P < 0.05): plasma creatinine and proteinurea falling from 0.96 ± 0.65 to 0.75 ± 0.19 mg/dl (P < 0.14) and from 1.64 ± 1.12 to 0.27 ± 0.60 gr/24 h (P < 0.001). By the end of 24-month, 95.8% of patients had been in remission. Four episodes of relapse ended in remission followed by retreatment. No life-threatening side effects were observed in 66.6% of patients with fourteen cases of infection (58.3%). None of them developed ESRD.Maintenance therapy with MMF was shown to yield favorable outcome with minimal complications, in treating lupus nephritis (IRCT2012071710313N1).

Immunosuppression With Mycophenolate Mofetil Attenuates Hypertension in an Experimental Model of Autoimmune Disease

“…This is in agreement with previous studies in which MMF treatment delayed onset of renal injury and lowered proteinuria levels . Clinically, patients with SLE who were administered MMF have been shown to have normal serum creatinine levels and decreased proteinuria . The possibility exists that the prevention of renal injury is the result of the blood pressure–lowering effect of MMF; however, this is unlikely for several reasons.…”

“…39 Clinically, patients with SLE who were administered MMF have been shown to have normal serum creatinine levels and decreased proteinuria. [58][59][60] The possibility exists that the prevention of renal injury is the result of the blood pressure-lowering effect of MMF; however, this is unlikely for several reasons. First, other established experimental models (ie, MRL/lpr) develop aggressive renal pathology that causes mortality typically by 20 weeks of age, but they do not develop hypertension.…”

Tuberculosis in patients with systemic lupus erythematosus–a 37‐year longitudinal survey‐based study

“…GCs and ISAs are the mainstay of SLE treatment; however, they increase the risk of developing TB and other opportunistic infections [3,[25][26][27][28]. In this study, SLE/TB + patients, especially those with active TB infections, received higher dosages of GCs and more CTX/MMF treatment before developing TB infection, all of which were not unexpected as these drugs are most commonly used in SLE patients and can profoundly affect the immune defence [2,7,12,[29][30][31]. Patients treated vigorously with GC, CTX and MMF should be alerted of TB infection.…”

Miliary Tuberculosis Presenting With Meningitis in a Patient Treated With Mycophenolate for Lupus Nephritis: Challenges in Diagnosis and Review of the Literature

“…It is therefore no surprise that infections are a common complication as both humoral and cellular immunity are profoundly suppressed. 11 , 12 However, when compared with the older agent cyclophosphamide, MMF causes less bone marrow suppression and hence is associated with less infectious complications. 7 , 10 When compared with azathioprine, the other first-line agent in the treatment of LN, studies have not shown a difference in rates of infection.…”