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DGReview
Mycophenolate Mofetil Appears Safe, Effective for Lupus Nephritis
A DGReview of :"Lupus nephritis: treatment with mycophenolate mofetil"
Rheumatology
01/27/2004
By Emma Hitt, PhD
Treatment with mycophenolate mofetil (MMF) appears to be safe and effective in patients with proliferative forms of lupus nephritis, new research suggests.
MMF reduces the rate of acute rejection following renal transplantation and has been used to treat patients with other immune-mediated disorders such as immunoglobulin A nephropathy, small-vessel vasculitides and psoriasis. While MMF has been demonstrated to be effective in mouse models of lupus nephritis, clinical research in patients is limited.
PP Kapitsinou, MD, with the Department of Pathophysiology at the Medical School, University of Athens, Greece and colleagues evaluated the safety and efficacy of MMF treatment in 18 patients with biopsy-proven lupus nephritis.
Patients included 17 females and 1 male with mean age 31.6 years; mean lupus duration 92 months; and mean duration of nephritis 57 months. Nine of the patients had focal proliferative glomerulonephritis, 3 had diffuse proliferative glomerulonephritis, and 6 had membranous nephropathy.
With the exception of 5 patients, all had been treated previously with cyclophosphamide and were selected because of either toxicity or inadequate clinical response to treatment. MMF was given at 2 g daily in combination with steroids for up to 31 months (mean 15.3 months).
Complete remission was observed in 10 of the patients and 4 went into partial remission. Creatinine clearance and proteinuria were significantly improved during MMF treatment in patients with the proliferative forms of nephritis. In addition, MMF demonstrated a steroid-sparing effect overall.
Treatment failed in 4 of the18 patients, all of whom had membranous nephropathy. Two patients developed gastrointestinal complaints, and infectious meningitis occurred in 1 patient.
"The efficacy of MMF in lupus membranous nephropathy remains unclear," the researchers note. They add that the present report is "not intended to definitively address the many critical issues of the role of MMF in the treatment of lupus nephritis. However, our study does indicate that MMF is a safe and probably efficacious treatment in patients with proliferative forms of lupus nephritis who do not respond or cannot tolerate conventional treatment," they suggest.
Rheumatology (Oxford). 2004 Jan 6 [Epub ahead of print].
"Lupus nephritis: treatment with mycophenolate mofetil"
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