title: Mycophenolate Mofetil in Nonrenal Manifestations of Systemic Lupus Erythematosus: An Observational Cohort Study.
abstract: OBJECTIVE
  Mycophenolate mofetil (MMF), along with corticosteroids, is considered as the standard of care in lupus nephritis (LN); however, little is known regarding its efficacy in extrarenal manifestations of systemic lupus erythematosus (SLE). We aimed to determine its effectiveness in nonrenal SLE.
  
  
  METHODS
  One hundred seventy-seven patients with SLE were enrolled; 105 for whom MMF was introduced for active LN (mean age 35.6 ± 10.7 yrs, mean disease duration 8.9 ± 7.8 yrs) and 72 for extrarenal manifestations (mean age 38.6 ± 11.7 yrs, mean disease duration 11.7 ± 9.2 yrs). The main indication for MMF initiation was based on the respective SLE Disease Activity Index element that was present at that time. Patients were subdivided according to the major nonrenal manifestation. Improvement was defined as the absence of the initial clinical or laboratory manifestation after 6 and 12 months.
  
  
  RESULTS
  Cumulatively, the initial clinical manifestation or hematological abnormality was resolved in 42/72 nonrenal patients (58.3%) after 6 months and in 45/72 (62.5%) after 12 months. Corticosteroid dose was reduced in 44/72 patients (61.1%, p < 0.001, mean dose 18.4 ± 12.6 mg/day at baseline to 12.1 ± 9.0 mg/day after 12 mos, p < 0.05). In renal patients, 40 (38.1%) had complete resolution of the extrarenal manifestation after 6 months, while 53 (50.5%) achieved complete response after 12 months. Prednisone dose was reduced in 73/105 patients (69.5%) after 12 months (mean dose 29.2 ± 16.6 mg/day at baseline to 15.3 ± 9.7 mg/day, p < 0.001).
  
  
  CONCLUSIONS
  MMF seems to be an efficacious alternative in refractory to standard of care nonrenal manifestations of SLE in the long term, allowing for disease activity control and significant reduction in corticosteroid dose.
authors.affiliation: From the Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, University Health Network, Toronto, Ontario, Canada.K. Tselios, MD, PhD, Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FCRPC, Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, University Health Network; J. Su, MB, BSc, Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, University Health Network; M.B. Urowitz, MD, FRCPC, Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, University Health Network.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tselios
authors.affiliation: From the Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, University Health Network, Toronto, Ontario, Canada.K. Tselios, MD, PhD, Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FCRPC, Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, University Health Network; J. Su, MB, BSc, Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, University Health Network; M.B. Urowitz, MD, FRCPC, Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, University Health Network.
authors.forename: Dafna D
authors.initials: DD
authors.lastname: Gladman
authors.affiliation: From the Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, University Health Network, Toronto, Ontario, Canada.K. Tselios, MD, PhD, Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FCRPC, Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, University Health Network; J. Su, MB, BSc, Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, University Health Network; M.B. Urowitz, MD, FRCPC, Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, University Health Network.
authors.forename: Jiandong
authors.initials: J
authors.lastname: Su
authors.affiliation: From the Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, University Health Network, Toronto, Ontario, Canada.K. Tselios, MD, PhD, Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FCRPC, Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, University Health Network; J. Su, MB, BSc, Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, University Health Network; M.B. Urowitz, MD, FRCPC, Centre for Prognosis Studies in Rheumatic Diseases, University of Toronto Lupus Clinic, University Health Network. m.urowitz@utoronto.ca.
authors.forename: Murray B
authors.initials: MB
authors.lastname: Urowitz
mesh_terms: D042842:11-beta-Hydroxysteroid Dehydrogenases / Q000627:therapeutic use*; D000328:Adult; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D008181:Lupus Nephritis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000627:therapeutic use*; D012074:Remission Induction; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D042842:11-beta-Hydroxysteroid Dehydrogenases; D009173:Mycophenolic Acid
keywords: MYCOPHENOLATE MOFETIL; NONRENAL MANIFESTATIONS; SYSTEMIC LUPUS ERYTHEMATOSUS