Mycophenolate mofetil in the treatment of lupus nephritis.
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.
Yong
Patrick Fk
PF
Department of Clinical Immunology, Kings College Hospital.
D'Cruz
David P
DP
Clin Exp Immunol. 1999 Jun;116(3):534-41
10361247
Nephrol Dial Transplant. 2003 May;18(5):878-83
12686658
J Am Soc Nephrol. 2004 Feb;15(2):241-50
14747370
Kidney Int. 2004 Dec;66(6):2411-5
15569333
Transplantation. 1999 Jul 27;68(2):261-6
10440399
Kidney Int. 1997 May;51(5):1583-9
9150476
Arthritis Rheum. 2004 Dec;50(12):3934-40
15593207
Am J Med Genet A. 2008 Jan 1;146A(1):1-7
18074358
Am J Kidney Dis. 2004 Feb;43(2):197-208
14750085
Pediatr Nephrol. 2007 Aug;22(8):1077-82
17370094
Clin Transplant. 2006;20 Suppl 17:25-9
17100698
Am J Transplant. 2004 Jan;4(1):108-15
14678041
Clin Chem. 1995 Jul;41(7):1011-7
7600680
N Engl J Med. 2004 Mar 4;350(10):971-80
14999109
Clin Pharmacokinet. 1998 Jun;34(6):429-55
9646007
J Am Soc Nephrol. 1998 Aug;9(8):1407-15
9697662
Am J Transplant. 2004 Feb;4(2):231-6
14974944
Lancet. 1992 Sep 26;340(8822):741-5
1356175
Am J Surg Pathol. 2006 Aug;30(8):1030-5
16861976
Drugs. 2006;66(9):1191-207
16827597
Pediatr Nephrol. 2006 May;21(5):655-62
16570203
Rheumatology (Oxford). 2005 Oct;44(10):1317-21
16049051
N Engl J Med. 2000 Oct 19;343(16):1156-62
11036121
J Am Soc Nephrol. 2002 Mar;13(3):759-768
11856782
Transplant Proc. 2004 Sep;36(7):2068-70
15518748
Lupus. 2006;15(5):308-18
16761508
Nephrology (Carlton). 2005 Oct;10(5):504-10
16221103
N Engl J Med. 2005 Nov 24;353(21):2219-28
16306519
Lupus. 2005;14 Suppl 1:s33-8
15803929
Kidney Int. 2004 Dec;66(6):2382-8
15569330
Ann Intern Med. 1996 Oct 1;125(7):549-57
8815753
Arthritis Rheum. 2002 Aug;46(8):2121-31
12209517
Transplant Proc. 1991 Apr;23(2 Suppl 2):10-4
2063415
Transplantation. 2005 Oct 15;80(2 Suppl):S244-53
16251857
Transplantation. 2006 May 15;81(9):1290-7
16699457
Lupus. 2002;11(7):411-8
12195781
Clin Nephrol. 2001 Apr;55(4):318-21
11334319
Braz J Infect Dis. 2006 Apr;10(2):132-8
16878265
J Am Soc Nephrol. 2006 Mar;17(3):871-80
16452491
Lupus. 2005;14(1):65-71
15732291
Immunopharmacology. 2000 May;47(2-3):85-118
10878285
J Am Soc Nephrol. 1999 Feb;10(2):413-24
10215343
Clin Nephrol. 2006 Aug;66(2):103-11
16939066
J Biol Chem. 1990 Mar 25;265(9):5292-5
1969416
J Biol Chem. 1993 Dec 25;268(36):27286-90
7903306
Transplantation. 2003 May 15;75(9 Suppl):37S-42S
12819489
J Rheumatol. 2001 Sep;28(9):2103-8
11550982
Rheumatology (Oxford). 2004 Mar;43(3):377-80
14963204
Lupus. 2006;15(6):371-9
16830884
Curr Opin Rheumatol. 2001 Sep;13(5):345-51
11604587
Lupus. 2002;11(3):152-60
12004788
Am J Transplant. 2007 Nov;7(11):2496-503
17908276
J Pharmacol Exp Ther. 2007 May;321(2):583-9
17272676
Transplant Proc. 1999 Feb-Mar;31(1-2):1250-2
10083559
J Lab Clin Med. 2001 Jul;138(1):69-77
11433230
N Engl J Med. 1986 Mar 6;314(10):614-9
3511372
Clin J Am Soc Nephrol. 2007 Sep;2(5):968-75
17702723
Arthritis Rheum. 2006 Sep;54(9):2963-9
16947632
Clin Exp Rheumatol. 1993 Mar-Apr;11 Suppl 8:S117-9
8324935
J Am Soc Nephrol. 2005 Apr;16(4):1076-84
15728784
Clin Nephrol. 2008 Feb;69(2):90-101
18218302
Lupus. 2007;16(12):972-80
18042591
Rheumatology (Oxford). 2007 Jul;46(7):1096-101
17409128
Lupus. 2008 Jan;17(1):40-5
18089682
Transplantation. 1995 Nov 27;60(10):1143-8
7482723
Clin Exp Immunol. 2003 Oct;134(1):63-9
12974756
Arthritis Res Ther. 2006;8(6):R182
17163990
Nephrol Dial Transplant. 2007 Jul;22(7):1933-42
17405792
J Rheumatol. 1998 Dec;25(12):2364-70
9858431
Kidney Int. 2001 Aug;60(2):653-63
11473648