Mycophenolate mofetil and intravenous cyclophosphamide are similar as induction therapy for class V lupus nephritis

Abstract

Class V lupus nephritis (LN) occurs in one-fifth of biopsy-proven cases of systemic lupus erythematosus. To study the effectiveness of treatments in this group of patients, we pooled analysis of two large randomized controlled multicenter trials of patients with diverse ethnic and racial background who had pure class V disease. These patients received mycophenolate mofetil (MMF) or intravenous cyclophosphamide (IVC) as induction therapy for 24 weeks, with percentage change in proteinuria and serum creatinine as end points. Weighted mean differences, pooled odds ratios, and confidence intervals were calculated by using a random-effects model. A total of 84 patients with class V disease were divided into equal groups, each group had comparable entry variables but one received MMF and one received IVC. Within these groups, 33 patients on MMF and 32 patients on IVC completed 24 weeks of treatment. There were no differences between the groups in mean values for the measured end points. Similarly, no difference was found regarding the number of patients who did not complete the study or who died. In patients with nephrotic syndrome, no difference was noted between those treated with MMF and IVC regarding partial remission or change in urine protein. Hence we found that the response to MMF as induction treatment of patients with class V LN appears to be no different from that to IVC.

Updates on the Treatment of Lupus Nephritis

“…In a pooled analysis of these participants, remissions, relapses, and overall clinical course were similar in the membranous patients treated with oral MMF and intravenous cyclophosphamide induction therapy (Figure 3). 50 The previously discussed study by Bao et al,32 in which MMF was combined with a calcineurin inhibitor, lays out yet another potentially useful treatment regi- men for cases of class V lupus nephritis associated with class IV proliferative lesions. Thus, for patients with membranous lupus nephritis with nephrotic range proteinuria, there are multiple treatment options including a course of oral cyclosporine or tacrolimus, monthly intravenous pulses of cyclophosphamide, oral MMF, or oral azathioprine plus corticosteroids.…”

Identification of biomarkers that predict response to treatment of lupus nephritis with mycophenolate mofetil or pulse cyclophosphamide

“…Dall'Era et al topathologic class did not predict outcome in the ALMS trial (6). Interestingly, baseline C4 but not C3 correlated with treatment response.…”

New and emerging treatments for lupus nephritis

“…31,32 Our center recently published an analysis of 84 patients with pure membranous lupus pooled from two large trials of MMF versus IV CYC for lupus nephritis. 33 There were no differences between the groups in remission, relapses, or clinical outcomes. In sum, the best evidence to date supports the use of either CYC, MMF, or a calcineurin inhibitor for membranous lupus nephritis.…”