Efficacy of mycophenolate mofetil in Japanese patients with systemic lupus erythematosus

Kawazoe, Mai; Kaneko, Kaichi; Yamada, Zento; Masuoka, Shotaro; Mizutani, Satoshi; Yamada, Soichi; Shikano, Kotaro; Sato, Hiroshi; Kaburaki, Makoto; Muraoka, Sei; Kawai, Shinichi; Nanki, Toshihiro

doi:10.1007/s10067-019-04473-w

Cited by 8 publications

(9 citation statements)

References 26 publications

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“…Over the previous several decades, MMF has been considered a main treatment to manage LN 567. Recently, MMF has been successfully used for management of non-renal manifestations 89101112. Nevertheless, there is not sufficient evidence to demonstrate confidence in the clinical efficacy of MMF for non-renal manifestations in SLE.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies have demonstrated that patients treated with MMF showed superior or equivalent effects on suppression of renal inflammation in LN compared to those treated with cyclophosphamide or azathioprine 567. In addition, there is increasing evidence that MMF has some beneficial effects on non-renal manifestations including hematologic and neuropsychiatric abnormalities refractory to other conventional therapeutics 89101112…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Mycophenolate Mofetil on Non-Renal Manifestations in Systemic Lupus Erythematosus: Results from Korean Lupus Network Registry

et al. 2019

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Background The objective of this study was to identify the effects of mycophenolate mofetil (MMF) on non-renal manifestations in systemic lupus erythematosus (SLE). Methods The study population comprised 439 SLE patients from the Korean Lupus Network registry who were followed up annually and completed the baseline survey and two follow-up visits from 2014 to 2018. Disease activity, laboratory markers, and clinical manifestations including mucocutaneous lesions, arthritis, serositis, neurological disorders, and hematologic/immunologic abnormalities were assessed. All variables by group (MMF and non-MMF) effects with time (baseline, 1st follow-up, and 2nd follow-up) were analyzed by generalized estimation equation. Results Seventy-two patients were treated with MMF. There was significant difference in frequencies of malar rash, arthritis, renal disorder, and hematologic disorder between MMF and non-MMF groups in total SLE patients. In subgroup analysis of hematologic abnormalities in total patients, frequency of leukopenia was significantly different between the two groups during follow-up ( P = 0.001), but frequencies of hemolytic anemia, lymphopenia, and thrombocytopenia were not. In addition, frequencies of leukopenia in patients without lupus nephritis were significantly decreased in MMF group compared to non-MMF group ( P = 0.012). Conclusion This study showed that MMF might be a beneficial treatment for hematologic abnormalities, especially leukopenia, in SLE.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Effect of Mycophenolate Mofetil on Non-Renal Manifestations in Systemic Lupus Erythematosus: Results from Korean Lupus Network Registry

et al. 2019

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“…Patients with autoimmune diseases treated with mycophenolate mofetil were recruited from April 2018 to January 2019. Eligibility criteria included (1) or malignant tumors; and (2) combination use of the following drugs: cyclosporine, tacrolimus, thalidomide, metal-containing drugs, cholestyramine, probenecid, and iron-rich foods or drugs that can affect the absorption and metabolism of MMF.…”

Section: Materials and Methods Subjectsmentioning

confidence: 99%

“…Because of the efficacy and safety of MMF in organ transplant recipients, increasing emerging evidence suggests the successfulness of utilizing MMF in treating patients with systemic lupus erythematosus, Sjogren's syndrome, and other autoimmune diseases. [1][2][3][4] MMF has been widely used because it is well tolerated and safer than other immunosuppressive agents and has fewer toxic side effects. Many studies have confirmed a positive correlation between MPA exposure and efficacy.…”

Section: Introductionmentioning

confidence: 99%

Influence of SLCO1B1 521T>C, UGT2B7 802C>T and IMPDH1 −106G>A Genetic Polymorphisms on Mycophenolic Acid Levels and Adverse Reactions in Chinese Autoimmune Disease Patients

Shu

Fan

Hua

et al. 2021

PGPM

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Introduction: Mycophenolate mofetil (MMF), a new type of immunosuppressant, has emerged as a frontline agent for treating autoimmune diseases. Mycophenolic acid (MPA) is an active metabolite of MMF. MPA exposure varies greatly among individuals, which may lead to adverse drug reactions such as gastrointestinal side effects, infection, and leukopenia. Genetic factors play an important role in the variation of MPA levels and its side effects. Although many published studies have focused on MMF use in patients after organ transplant, studies that examine the use of MMF in patients with autoimmune diseases are still lacking. Methods: This study will not only explore the genetic factors affecting MPA levels and adverse reactions but also investigate the relationships between UGT1A9 −118(dT)9/10, UGT1A9 -1818T>C, UGT2B7 802C>T, SLCO1B1 521T>C, SLCO1B3 334T>G, IMPDH1 −106G>A and MPA trough concentration (MPA C 0 ), along with adverse reactions among Chinese patients with autoimmune diseases. A total of 120 patients with autoimmune diseases were recruited. The MPA trough concentration was detected using the enzyme multiplied immunoassay technique (EMIT). Genotyping was performed using a real-time polymerase chain reaction (PCR) system and validated allelic discrimination assays. Clinical data were collected for the determination of side effects. Results: SLCO1B1 521T>C demonstrated a significant association with MPA C 0 /d (p=0.003), in which patients with the CC type showed a higher MPA C 0 /d than patients with the TT type (p=0.001) or the CT type (p=0.000). No significant differences were found in MPA C 0 /d among the other SNPs. IMPDH1 −106G>A was found to be significantly related to infections (p=0.006). Subgroup analysis revealed that UGT2B7 802C>T was significantly related to Pneumocystis carinii pneumonia infection (p=0.036), while SLCO1B1 521T>C was associated with anemia (p=0.029). Conclusion:For Chinese autoimmune disease patients, SLCO1B1 521T>C was correlated with MPA C 0 /d and anemia. IMPDH1 −106G>A was significantly related to infections. UGT2B7 802C>T was significantly related to Pneumocystis carinii pneumonia infection.

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“…We have conventionally used tacrolimus (TAC) to treat LN after induction therapy with IVCY. TAC is a calcineurin inhibitor that suppresses T-cell responses and is effective against various manifestations of SLE, [8][9][10][11][12] including nephritis. [13][14][15] To the best of our knowledge, the efficacy of induction therapy with IVCY followed by maintenance therapy with TAC has not yet been compared with that of continuous MMF as induction and maintenance therapies.…”

Section: Introductionmentioning

confidence: 99%

Comparison of efficacy of continuous mycophenolate mofetil with sequential cyclophosphamide and tacrolimus as maintenance therapy for lupus nephritis

Kawazoe,

Nanki

2024

Lupus

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Objectives To evaluate the renal response to mycophenolate mofetil (MMF) as maintenance therapy for lupus nephritis (LN) in Japanese patients, we compared the efficacy of MMF and the sequential use of monthly intravenous cyclophosphamide (IVCY) followed by tacrolimus (TAC). Methods We examined 14 patients with LN who were treated with continuous MMF as induction and maintenance therapies (MMF group) and 10 patients with LN who received monthly IVCY as induction therapy followed by maintenance therapy with TAC (IVCY-TAC group). We assessed the therapeutic effects of each treatment regimen on renal manifestations and serological findings over a 36-month period after treatment initiation. Results Mean urine protein-to-creatinine ratios in the MMF and IVCY-TAC groups significantly decreased from 2.75 to 0.11 g/gCr and from 3.26 to 0.22 g/gCr, respectively. Significant improvements in serum immunological variables (serum complement C3 or C4 levels and the anti-double-stranded DNA antibody titer) and reductions in the SLE disease activity index and daily prednisolone dosages were observed in both groups during induction therapy and were maintained during maintenance therapy. Efficacy was similar between the MMF and IVCY-TAC groups. Conclusion MMF has potential as an effective treatment for renal manifestations in Japanese patients throughout induction and maintenance therapies for LN, as an alternative to conventional IVCY-TAC therapy, and as a glucocorticoid-sparing agent.

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Efficacy of mycophenolate mofetil in Japanese patients with systemic lupus erythematosus

Cited by 8 publications

References 26 publications

The Effect of Mycophenolate Mofetil on Non-Renal Manifestations in Systemic Lupus Erythematosus: Results from Korean Lupus Network Registry

The Effect of Mycophenolate Mofetil on Non-Renal Manifestations in Systemic Lupus Erythematosus: Results from Korean Lupus Network Registry

Influence of SLCO1B1 521T>C, UGT2B7 802C>T and IMPDH1 −106G>A Genetic Polymorphisms on Mycophenolic Acid Levels and Adverse Reactions in Chinese Autoimmune Disease Patients

Comparison of efficacy of continuous mycophenolate mofetil with sequential cyclophosphamide and tacrolimus as maintenance therapy for lupus nephritis

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