Should mycophenolate mofetil replace cyclophosphamide as first-line therapy for severe lupus nephritis?
Available treatments for severe (class III, IV, and V) lupus nephritis (LN) have expanded greatly over the last 40 years. In the 1970s and 1980s, cyclophosphamide (CYC), in combination with glucocorticoids, gained favor as induction and maintenance therapy for severe LN. However, the adverse event profile of CYC led to the search for other medications for severe LN. Beginning in the late 1990 s, mycophenolate mofetil (MMF) was introduced as induction and maintenance therapy for severe LN. This review discusses the clinical trial results, pharmacology, cost-effectiveness, and adverse effect profiles of CYC compared to MMF for induction and maintenance therapy for severe LN. The authors conclude that MMF should be considered first-line induction and maintenance treatment therapy for severe LN, although CYC may have a place under specific clinical and economic circumstances.
Division of Nephrology, Department of Medicine, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
Jonathan
J
Hogan
Michael H
MH
Schwenk
Jai
J
Radhakrishnan
D003362:Cost-Benefit Analysis; D003520:Cyclophosphamide / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D008181:Lupus Nephritis / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D009173:Mycophenolic Acid