Lupus, Sjögren's Syndrome, Scleroderma, and Related Conditions
Ask The Expert: Role of Mycophenolate Mofetil in Lupus Nephritis?
Posted 09/30/2002 from Medscape Rheumatology
Question: What is the role of mycophenolate mofetil in lupus nephritis? Is it superior or equal in effectiveness to cyclophosphamide?
Response from Arthur Kavanaugh, MD, 09/30/2002
There are several difficulties affecting the ability to assess therapies in a disease such as lupus nephritis. Because of the substantial heterogeneity of the disease process, it is often hard to compare populations treated in one study with those treated in other studies. Also, as medical treatment has evolved over time, there are other factors that affect patient survival and renal and other outcomes. For lupus nephritis, progress in the development of antihypertensive agents and intensive-care unit management probably has had a beneficial role in patient outcome. Thus, it is hard to compare the results observed in a contemporary study with those observed in a study from a decade or 2 in the past.
With these caveats, there have been several studies that have suggested that mycophenolate mofetil may be a useful treatment for lupus nephritis. In a study[1,2] of 42 patients from Hong Kong with World Health Organization type 4 lupus nephritis, the extent of complete remission with mycophenolate was comparable to that achieved with cyclophosphamide (oral, beginning at 2.5 mg/kg/day for 6 months, followed by azathioprine). Tolerability favored mycophenolate. Overall, the data suggest that this may be a viable treatment option for lupus nephritis. However, another consideration that may affect the use of this agent is its relatively high cost.
Dooley MA, Cosio F, Nachman P, et al. Mycophenolate mofetil therapy in lupus nephritis: clinical observations. J Am Soc Nephrol. 1999;10:833-839.
Chan TM, Li FK, Tang CSO, et al. Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. N Engl J Med. 2000;343:1156-1162.
About the Panel Members
Arthur Kavanaugh, MD, Director, Center for Innovative Therapy, Division of Rheumatology, Allergy, and Immunology, University of California at San Diego.