title: Mycophenolate mofetil for systemic lupus erythematosus refractory to other immunosuppressive agents.
abstract: BACKGROUND
  Mycophenolate mofetil (MMF) is an immunosuppressive drug widely used in solid organ transplantation, and it may play an increasing role in autoimmune disease. MMF has been introduced as a novel immunosuppressive agent in systemic lupus erythematosus (SLE), often in patients intolerant of or resistant to conventional immunosuppressive regimens.
  
  
  METHODS
  We studied 21 patients with SLE, most of whom had previously received courses of cyclophosphamide therapy and had also received courses of azathioprine or methotrexate. Indications for treatment included uncontrolled disease activity and worsening renal involvement.
  
  
  RESULTS
  MMF treatment resulted in reduced disease activity, as assessed by the SLEDAI (SLE disease activity index) (P=0.0001) and decreased proteinuria (P=0.027) while allowing a significant reduction in oral corticosteroid dose (P=0.0001). Levels of complement factors C3 and C4 and anti-double-stranded DNA antibodies were not significantly affected.
  
  
  CONCLUSIONS
  MMF appears to be a safe and effective alternative immunosuppressant for extra-renal and renal disease in SLE not responding to conventional immunosuppressive treatment.
authors.affiliation: Lupus Research Unit, The Rayne Institute, Immunology Department, St Thomas' Hospital, London, UK.
authors.forename: M Y
authors.initials: MY
authors.lastname: Karim
authors.forename: P
authors.initials: P
authors.lastname: Alba
authors.forename: M-J
authors.initials: MJ
authors.lastname: Cuadrado
authors.forename: I C
authors.initials: IC
authors.lastname: Abbs
authors.forename: D P
authors.initials: DP
authors.lastname: D'Cruz
authors.forename: M A
authors.initials: MA
authors.lastname: Khamashta
authors.forename: G R V
authors.initials: GR
authors.lastname: Hughes
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood; D001379:Azathioprine / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D011507:Proteinuria / Q000517:prevention & control; D044469:Racial Groups; D018709:Statistics, Nonparametric; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000974:Antibodies, Antinuclear; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D009173:Mycophenolic Acid; D001379:Azathioprine; D008727:Methotrexate