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: 4.89). 06/2011; 23(5):454-8. DOI: 10.1097/BOR.0b013e328349a1e5
Source: PubMed


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.

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