Article

Mycophenolate mofetil in the treatment of systemic lupus erythematosus

University of California, San Francisco, San Francisco, California 94143-0633, USA.
Current opinion in rheumatology (Impact Factor: 5.07). 06/2011; 23(5):454-8. DOI: 10.1097/BOR.0b013e328349a1e5
Source: PubMed

ABSTRACT Clinicians are increasingly using mycophenolate mofetil (MMF) for the treatment of systemic lupus erythematosus (SLE). This review will discuss the key studies that have contributed to our understanding of the efficacy and safety of MMF in the treatment of SLE.
The Aspreva Lupus Management Study (ALMS) firmly established that MMF is equivalent to intravenous pulse cyclophosphamide (IVC) for the induction treatment of lupus nephritis. In addition, MMF was shown to be superior to azathioprine in decreasing the incidence of treatment failure during maintenance therapy. A posthoc analysis of the induction phase of ALMS suggested that MMF also improved nonrenal manifestations of SLE. In contrast to the ALMS maintenance results, a European trial concluded that MMF and azathioprine were equivalent in the ability to prevent renal flare after induction treatment with low-dose IVC.
Favorable efficacy and safety results of several clinical trials conducted over the past 10 years have led to the adoption of MMF for the treatment of lupus nephritis and nonrenal lupus. Future research will be important to more fully understand the best dosing regimen of MMF for induction versus maintenance treatment, total duration of treatment, and the utility of therapeutic monitoring of MMF levels.

3 Followers
 · 
408 Views
 · 
7 Downloads
  • Source
    • "Efforts to develop alternative regimens with similar or better efficacy and safety than repeated intravenous cyclophosphamide administration have focused on mycophenolate mofetil [14] and biologic agents such as rituximab. Although intravenous rituximab has been beneficial in many case reports, it has lacked efficacy in controlled trials [15,16]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Although the combination of cyclophosphamide and rituximab has been utilized in case reports, there are no previous reports of the long term outcome of SLE treated systematically with this regimen. We report a pilot study to evaluate the efficacy of a systematically administered course of rituximab and cyclophosphamide over an eighteen month period to provide sustained improvement in childhood onset systemic lupus erythematosus (SLE). Twelve patients with childhood onset lupus nephritis or corticosteroid resistant SLE received systematic treatment with a combination of rituximab (750 mg/M2 up to 1 gram) and cyclophosphamide (750 mg/M2: no patient exceeded 1.8 M2). Two administrations of rituximab and cyclophosphamide, two weeks apart, were administered at the start of study, six months later, and eighteen months later. Clinical data were collected and analyzed after sixty months of follow up. There was sustained improvement in all clinical parameters with a dramatic reduction in both mean SLEDAI score (10.1 to 1 at one year and 0 at five years p<0.005) and mean daily prednisone dosage (29.7 mg/day to 12.7 by one year and 7.0 mg/day at five years p<0.005), with sustained improvement in mean C3 (55.5 mg/ml to 113 at one year and 107.5 at five years p<0.001) which was maintained through sixty months of follow up. Serum immunoglobulin levels were transiently depressed but mean values were within the normal range for both IgG and IgM at one and five years. Few complications were observed (two episodes of febrile neutropenia during the first year of treatment were the only serious adverse events) and patients routinely reported sustained wellbeing. This pilot study demonstrates that a systematically administered course of rituximab and cyclophosphamide over an eighteen month period provided sustained relief for patients with childhood onset SLE which was maintained over a sixty month period, while minimizing the need for corticosteroids, without excessive toxicity.
    Pediatric Rheumatology 01/2014; 12(1):3. DOI:10.1186/1546-0096-12-3 · 1.62 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Summary In this paper we define "resistant lupus erythematosus" and review 3 difficult problems with special attention in treatment. We consider the "NIH regimen" in proliferative glomerulo- nephritis and alternative treatments with cyclospo- rine, mycophenolate and experimental therapy in resistant patients. For steroid resistant throm- bocytopenia we analyze splenectomy and other
  • Source
    Arthritis & Rheumatology 02/2001; 45(1):86 - 100. DOI:10.1002/1529-0131(200102)45:1<86::AID-ANR89>3.0.CO;2-A · 7.87 Impact Factor
Show more

Preview

Download
7 Downloads
Available from