title: [Mycophenolate mofetil in the treatment of lupus nephritis, in patients with failure, intolerance or relapses after treatment with steroids and cyclophosphamide].
abstract: Intravenous cyclophosphamide (IVCP) in combination with oral steroids (ST) is the most widely accepted therapy for severe lupus nephritis (LN); however, its side effects, lack of response and relapses, have led to other treatment alternatives. being sought. Mycophenolate mofetil (MMF) has been shown to be effective in these cases. We studied the course over 12 months of 28 patients with LN WHO class III(n=3), IV(n=22) or V(n=3), with 38,1 +/- 11,4 tears of age, proteinuria 4,2 +/- 2,6 g /24 hours and serum creatinine 1,4 +/- 0,8 mg/dL, who, after being initially treated with ST and IVCP, showed no response(n=21), frequent relapses(n=6), or adverse side effects(n=1). All patients were treated with MMF in doses of 1000 to 2000 mg/day combined with ST or cyclosporine for one year. Four patients withdrew from treatment before the end of the follow-up. None of the patients who completed the study showed changes in hematologic parameters. Creatinine and creatinine clearance remained stable. Resulted in a significant improvement; serum albumine (3 +/- 0,8 vs 3,9 +/- 0,5 g/dL) p<0.01, and decreased of proteinuria (4,2 +/- 2,6 vs 1,8 +/- 2,2 g/ 24 hours) p<0.05, complement fractions improvement significantly, C3 and CH50 p<0.05, C4 p<0.01. Antinuclear antibodies (ANA) and anti-DNA antibodies decreased significantly (p<0.05). During follow-up, a reduction in the ST dose was achieved: 18.3 +/- 10,5 vs 10,1 +/- 4,1 mg/24h (p<0.01). Three mild side effects related to MMF were observed and only 1 case required discontinuation of treatment. We concluded that MMF is a useful drug in the treatment and control of lupus nephritis, which also allows for a significant reduction in the dose of ST, with minimal side effects.
authors.affiliation: Nefrología, Hospital Insular de Gran Canaria, Avda, Marítma del Sur, Las Palmas. ssurgon@gobiernodecanarias.org
authors.forename: S
authors.initials: S
authors.lastname: Suría
authors.forename: M D
authors.initials: MD
authors.lastname: Checa
mesh_terms: D000328:Adult; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008181:Lupus Nephritis / Q000188:drug therapy*; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D013256:Steroids / Q000627:therapeutic use; D017211:Treatment Failure
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D003520:Cyclophosphamide; D009173:Mycophenolic Acid