The safety and efficacy of MMF in lupus nephritis: a pilot study

Inducing and maintaining remission in patients with lupus nephritis may be difficult. Current treatments have significant toxicity. Mycophenolate mofe til (MMF) limits damage in murine models of lupus nephritis. We have assess ed the efficacy and tolerability of MMF in the treatment of patients with l ong-standing or resistant lupus nephritis. We have treated 13 patients with biopsy proven lupus nephritis (two membranous nephropathy, four membranous nephropathy with superimposed proliferative changes, seven with proliferat ive glomerulonephritis). All patients had relapsed on conventional treatmen t or there were pressing indications to minimise steroid dosage or avoid al kylating agents. Nine out of 13 were treated with MMF and prednisolone, 3/1 0 with MMF alone and 1/10 with MMF, prednisolone and cyclosporine. Thirteen patients were treated with MMF for up to 37 months (median 25 months). Thr ee patients were withdrawn from MMF during the first 8 months of treatment. The remainder tolerated MMF (median dose 1 g/day). Serological improvement s were observed in 9/13 and steroid dosage was reduced in 8/10 patients. In fections occurred in 3/13. One patient relapsed. MMF significantly reduced the rate of decline of renal function. MMF should be considered in the trea tment of long-standing or resistant lupus nephritis. Controlled clinical tr ials are required to confirm these findings.