title: Mycophenolate mofetil in the treatment of lupus nephritis.
abstract: Lupus nephritis is a complication of systemic lupus erythematosus, which has significant morbidity and mortality. The accepted standard of treatment for severe lupus nephritis is cyclophosphamide for induction of remission. This has significant adverse effects including severe infection and amenorrhea. In addition, although cyclophosphamide induces remission, long-term mortality does not seem to be altered. Mycophenolate mofetil (MMF) is an immunosuppressive agent originally used in solid organ transplantation, which has been compared with cyclophosphamide in trials for lupus nephritis. Randomized trials with MMF have been relatively small, although pooled data seem to suggest that it is at least as effective as cyclophosphamide in inducing remission. In addition, MMF has also been associated with a reduced risk of infection and amenorrhea, although this finding is not universal. MMF appears to be associated with more diarrhea compared with cyclophosphamide. MMF is likely to be a useful treatment for lupus nephritis, although available trial data are limited due to the small size of previous studies. A large trial (the Aspreva Lupus Management Study) is currently underway to attempt to establish the place of MMF in treatment of lupus nephritis.
authors.affiliation: Department of Clinical Immunology, Kings College Hospital.
authors.forename: Patrick Fk
authors.initials: PF
authors.lastname: Yong
authors.forename: David P
authors.initials: DP
authors.lastname: D'Cruz
references.citation: Clin Exp Immunol. 1999 Jun;116(3):534-41
references.pmid: 10361247
references.citation: Nephrol Dial Transplant. 2003 May;18(5):878-83
references.pmid: 12686658
references.citation: J Am Soc Nephrol. 2004 Feb;15(2):241-50
references.pmid: 14747370
references.citation: Kidney Int. 2004 Dec;66(6):2411-5
references.pmid: 15569333
references.citation: Transplantation. 1999 Jul 27;68(2):261-6
references.pmid: 10440399
references.citation: Kidney Int. 1997 May;51(5):1583-9
references.pmid: 9150476
references.citation: Arthritis Rheum. 2004 Dec;50(12):3934-40
references.pmid: 15593207
references.citation: Am J Med Genet A. 2008 Jan 1;146A(1):1-7
references.pmid: 18074358
references.citation: Am J Kidney Dis. 2004 Feb;43(2):197-208
references.pmid: 14750085
references.citation: Pediatr Nephrol. 2007 Aug;22(8):1077-82
references.pmid: 17370094
references.citation: Clin Transplant. 2006;20 Suppl 17:25-9
references.pmid: 17100698
references.citation: Am J Transplant. 2004 Jan;4(1):108-15
references.pmid: 14678041
references.citation: Clin Chem. 1995 Jul;41(7):1011-7
references.pmid: 7600680
references.citation: N Engl J Med. 2004 Mar 4;350(10):971-80
references.pmid: 14999109
references.citation: Clin Pharmacokinet. 1998 Jun;34(6):429-55
references.pmid: 9646007
references.citation: J Am Soc Nephrol. 1998 Aug;9(8):1407-15
references.pmid: 9697662
references.citation: Am J Transplant. 2004 Feb;4(2):231-6
references.pmid: 14974944
references.citation: Lancet. 1992 Sep 26;340(8822):741-5
references.pmid: 1356175
references.citation: Am J Surg Pathol. 2006 Aug;30(8):1030-5
references.pmid: 16861976
references.citation: Drugs. 2006;66(9):1191-207
references.pmid: 16827597
references.citation: Pediatr Nephrol. 2006 May;21(5):655-62
references.pmid: 16570203
references.citation: Rheumatology (Oxford). 2005 Oct;44(10):1317-21
references.pmid: 16049051
references.citation: N Engl J Med. 2000 Oct 19;343(16):1156-62
references.pmid: 11036121
references.citation: J Am Soc Nephrol. 2002 Mar;13(3):759-768
references.pmid: 11856782
references.citation: Transplant Proc. 2004 Sep;36(7):2068-70
references.pmid: 15518748
references.citation: Lupus. 2006;15(5):308-18
references.pmid: 16761508
references.citation: Nephrology (Carlton). 2005 Oct;10(5):504-10
references.pmid: 16221103
references.citation: N Engl J Med. 2005 Nov 24;353(21):2219-28
references.pmid: 16306519
references.citation: Lupus. 2005;14 Suppl 1:s33-8
references.pmid: 15803929
references.citation: Kidney Int. 2004 Dec;66(6):2382-8
references.pmid: 15569330
references.citation: Ann Intern Med. 1996 Oct 1;125(7):549-57
references.pmid: 8815753
references.citation: Arthritis Rheum. 2002 Aug;46(8):2121-31
references.pmid: 12209517
references.citation: Transplant Proc. 1991 Apr;23(2 Suppl 2):10-4
references.pmid: 2063415
references.citation: Transplantation. 2005 Oct 15;80(2 Suppl):S244-53
references.pmid: 16251857
references.citation: Transplantation. 2006 May 15;81(9):1290-7
references.pmid: 16699457
references.citation: Lupus. 2002;11(7):411-8
references.pmid: 12195781
references.citation: Clin Nephrol. 2001 Apr;55(4):318-21
references.pmid: 11334319
references.citation: Braz J Infect Dis. 2006 Apr;10(2):132-8
references.pmid: 16878265
references.citation: J Am Soc Nephrol. 2006 Mar;17(3):871-80
references.pmid: 16452491
references.citation: Lupus. 2005;14(1):65-71
references.pmid: 15732291
references.citation: Immunopharmacology. 2000 May;47(2-3):85-118
references.pmid: 10878285
references.citation: J Am Soc Nephrol. 1999 Feb;10(2):413-24
references.pmid: 10215343
references.citation: Clin Nephrol. 2006 Aug;66(2):103-11
references.pmid: 16939066
references.citation: J Biol Chem. 1990 Mar 25;265(9):5292-5
references.pmid: 1969416
references.citation: J Biol Chem. 1993 Dec 25;268(36):27286-90
references.pmid: 7903306
references.citation: Transplantation. 2003 May 15;75(9 Suppl):37S-42S
references.pmid: 12819489
references.citation: J Rheumatol. 2001 Sep;28(9):2103-8
references.pmid: 11550982
references.citation: Rheumatology (Oxford). 2004 Mar;43(3):377-80
references.pmid: 14963204
references.citation: Lupus. 2006;15(6):371-9
references.pmid: 16830884
references.citation: Curr Opin Rheumatol. 2001 Sep;13(5):345-51
references.pmid: 11604587
references.citation: Lupus. 2002;11(3):152-60
references.pmid: 12004788
references.citation: Am J Transplant. 2007 Nov;7(11):2496-503
references.pmid: 17908276
references.citation: J Pharmacol Exp Ther. 2007 May;321(2):583-9
references.pmid: 17272676
references.citation: Transplant Proc. 1999 Feb-Mar;31(1-2):1250-2
references.pmid: 10083559
references.citation: J Lab Clin Med. 2001 Jul;138(1):69-77
references.pmid: 11433230
references.citation: N Engl J Med. 1986 Mar 6;314(10):614-9
references.pmid: 3511372
references.citation: Clin J Am Soc Nephrol. 2007 Sep;2(5):968-75
references.pmid: 17702723
references.citation: Arthritis Rheum. 2006 Sep;54(9):2963-9
references.pmid: 16947632
references.citation: Clin Exp Rheumatol. 1993 Mar-Apr;11 Suppl 8:S117-9
references.pmid: 8324935
references.citation: J Am Soc Nephrol. 2005 Apr;16(4):1076-84
references.pmid: 15728784
references.citation: Clin Nephrol. 2008 Feb;69(2):90-101
references.pmid: 18218302
references.citation: Lupus. 2007;16(12):972-80
references.pmid: 18042591
references.citation: Rheumatology (Oxford). 2007 Jul;46(7):1096-101
references.pmid: 17409128
references.citation: Lupus. 2008 Jan;17(1):40-5
references.pmid: 18089682
references.citation: Transplantation. 1995 Nov 27;60(10):1143-8
references.pmid: 7482723
references.citation: Clin Exp Immunol. 2003 Oct;134(1):63-9
references.pmid: 12974756
references.citation: Arthritis Res Ther. 2006;8(6):R182
references.pmid: 17163990
references.citation: Nephrol Dial Transplant. 2007 Jul;22(7):1933-42
references.pmid: 17405792
references.citation: J Rheumatol. 1998 Dec;25(12):2364-70
references.pmid: 9858431
references.citation: Kidney Int. 2001 Aug;60(2):653-63
references.pmid: 11473648