title: Mycophenolate in refractory and relapsing lupus nephritis.
abstract: BACKGROUND
  Mycophenolate (MF) is effective as induction and maintenance treatment in patients with lupus nephritis (LN). This study evaluates the efficacy and safety of MF in patients with refractory and relapsing LN.
  
  
  METHODS
  Data were retrospectively obtained for 85 patients (35 refractory and 50 relapsing) from 11 nephrology departments in Spain. The primary endpoints were the incidence and cumulative number of renal responses and relapses and their relationship with baseline clinical and analytical data. The secondary endpoint was the appearance of side effects.
  
  
  RESULTS
  The main clinical and analytical variables were similar both in refractory and relapsing LN. Most of the patients had received cyclophosphamide, and all of them switched to MF. 74 patients (87%) achieved a response (69% partial, 31% complete). Age at starting MF, gender, pathological classification, body mass index, blood pressure, baseline renal function, and proteinuria were not associated with achieving response. After stopping MF, 3 of 19 patients (15.7%) relapsed, all at 6 months of follow-up. No differences were found between clinical and analytical variables and number of relapses. Side effects were unremarkable, except for 1 patient, who died of thrombocytopenia and ovarian hemorrhage.
  
  
  CONCLUSIONS
  Switching to MF from other immunosuppressive treatments is effective and safe in refractory and relapsing LN.
authors.affiliation: Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Rivera
authors.forename: Evangelina
authors.initials: E
authors.lastname: Mérida
authors.forename: Maria L
authors.initials: ML
authors.lastname: Illescas
authors.forename: E
authors.initials: E
authors.lastname: López-Rubio
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Frutos
authors.forename: Patricia
authors.initials: P
authors.lastname: García-Frías
authors.forename: Carmela
authors.initials: C
authors.lastname: Ramos
authors.forename: María
authors.initials: M
authors.lastname: Sierra
authors.forename: José
authors.initials: J
authors.lastname: Baltar
authors.forename: Jesús
authors.initials: J
authors.lastname: Lucas
authors.forename: Aniana
authors.initials: A
authors.lastname: Oliet
authors.forename: Ana
authors.initials: A
authors.lastname: Vigil
authors.forename: Gema
authors.initials: G
authors.lastname: Fernández-Juárez
authors.forename: Alfons
authors.initials: A
authors.lastname: Segarra
authors.forename: Manuel
authors.initials: M
authors.lastname: Praga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003520:Cyclophosphamide / Q000627:therapeutic use; D003967:Diarrhea / Q000139:chemically induced; D057915:Drug Substitution; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007239:Infections / Q000139:chemically induced / Q000382:microbiology; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D013030:Spain; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D009173:Mycophenolic Acid