title: Mycophenolate mofetil as maintenance therapy for childhood-onset systemic lupus erythematosus patients with severe lupus nephritis.
abstract: OBJECTIVE
  We evaluated histological changes occurring in renal biopsy specimens, between the time before initial induction therapy and after 12 months' maintenance therapy, as well as changes in laboratory parameters, SLE disease activity (SLEDAI), and dosage of corticosteroid (CS) in childhood-onset systemic lupus erythematosus (SLE) patients treated with mycophenolate mofetil (MMF).
  
  
  METHODS
  A retrospective analysis was performed on nine patients diagnosed with childhood-onset SLE and lupus nephritis. They were treated with pulsed mPSL and intravenous cyclophosphamide as induction therapy and MMF (500-1500 mg/day) plus CS as maintenance therapy. Renal biopsy was performed before the initial induction therapy and after 12 months' maintenance therapy.
  
  
  RESULTS
  Pathological findings at second biopsy were improved in eight of nine patients (89%). The findings of SLEDAI, urinalysis, and blood tests also showed improvement. CS doses could be tapered satisfactorily. Adverse events were observed in two patients. No patients treated with MMF experienced any disease flares during maintenance therapy.
  
  
  CONCLUSIONS
  MMF as maintenance therapy might be useful in that not only the histological findings of lupus nephritis were improved, but also CS doses could be beneficially tapered. Nonetheless, this is a retrospective report of only nine cases and further prospective multicenter studies are necessary.
authors.affiliation: Department of Pediatrics, Yokohama City University School of Medicine , Yokohama , Japan.
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Kizawa
authors.forename: Tomo
authors.initials: T
authors.lastname: Nozawa
authors.forename: Masako
authors.initials: M
authors.lastname: Kikuchi
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Nagahama
authors.forename: Koji
authors.initials: K
authors.lastname: Okudela
authors.forename: Takako
authors.initials: T
authors.lastname: Miyamae
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Imagawa
authors.forename: Tomoko
authors.initials: T
authors.lastname: Nakamura
authors.forename: Masaaki
authors.initials: M
authors.lastname: Mori
authors.forename: Shumpei
authors.initials: S
authors.lastname: Yokota
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsutsumi
mesh_terms: D000293:Adolescent; D002648:Child; D003520:Cyclophosphamide / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007668:Kidney / Q000473:pathology; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000473:pathology; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D009173:Mycophenolic Acid; D008775:Methylprednisolone
keywords: Childhood-onset systemic lupus erythematosus; Intravenous cyclophosphamide; Lupus nephritis; Mycophenolate mofetil