Mycophenolate mofetil therapy in lupus nephritis: Clinical observations

Controlled clinical trials in renal transplantation have demonstrated that mycophenolate mofetil is well tolerated and has lower renal transplant reje ction rates than azathioprine regimens. This study reports on the clinical experiences at two institutions with mycophenolate mofetil (MMF) for severe lupus nephritis. Twelve patients with relapsing or resistant nephritis pre viously treated with cyclophosphamide therapy and one patient who refused c yclophosphamide as initial therapy for diffuse proliferative nephritis but accepted MMF were included. During combined MMF/prednisone therapy, serum c reatinine values remained normal or declined from elevated values: mean cha nge in serum creatinine was -0.26 +/- 0.46 mu M/L, P = 0.039. Proteinuria s ignificantly decreased: mean change in urine protein-to-creatinine ratios w as -2.53 +/- 3.76, P = 0.039. Decreased serum complement component C3 and e levated anti-double-stranded DNA antibody levels at baseline improved in so me, but not all, patients. The mean initial dose of MMF was 0.92 g/d (range , 0.5 to 2 g/d). The mean duration of therapy was 12.9 mo (range, 3 to 24 m o). Adverse events included herpes simplex stomatitis associated with sever e leukopenia (n = 1), asymptomatic leukopenia (n = 2), nausea/diarrhea (n = 2), thinning of scalp hair (n = 1), pancreatitis (n = 1), and pneumonia wi thout leukopenia (n = 1). Recurrence of the pancreatitis led to discontinua tion of MMF in this patient; all other adverse events resolved with dose re duction. It is concluded that MMF is well tolerated and has possible effica cy in controlling major renal manifestations of systemic lupus erythematosu s. Controlled clinical trials are needed to define the role of MMF in the m anagement of lupus nephritis.