Mycophenolate Mofetil in Low Doses Stabilizes and Improves Antineutrophil Cytoplasmic Antibody-associated Vasculitis and Lupus Nephritis

• Published in: Archives of medical research 2008, Vol.39 (1), p.115-119
• Main Authors: Kazderova, Marketa, Jancova, Eva, Rysava, Romana, Merta, Miroslav, Tesar, Vladimir
• Format: Article
• Language: English
• Subjects: ANCA-associated vasculitis; Autoantibodies - immunology; Female; Glomerulonephritis; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Internal Medicine; Lupus Erythematosus, Systemic - drug therapy; Lupus Erythematosus, Systemic - immunology; Lupus nephritis; Lupus Nephritis - complications; Lupus Nephritis - drug therapy; Male; Mycophenolate mofetil; Mycophenolic Acid - adverse effects; Mycophenolic Acid - analogs & derivatives; Mycophenolic Acid - therapeutic use; Neutrophils - immunology; Retrospective Studies; Systemic lupus erythematosus; Treatment Outcome; Vasculitis - drug therapy; Vasculitis - immunology
• ISSN: 0188-4409; 1873-5487
• DOI: 10.1016/j.arcmed.2007.07.006

Background Clinical experience with mycophenolate mofetil (MMF) in glomerulonephritis still remains limited. Methods In order to assess the experience of one center with the efficacy and tolerability of MMF in patients with glomerulonephritis, we performed a retrospective 6-year analysis of 68 patients treated by MMF for glomerular disease, mainly anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV: n = 34) and systemic lupus erythematosus and lupus nephritis (SLE: n = 24). Indications were maintenance treatment in 40% of patients, induction treatment in patients not tolerating cyclophosphamide in 27%, and disease relapse in 33%. Mean treatment duration was 11.5 months. Results Efficacy endpoints were serum creatinine, urinary protein excretion, and steroid dose. In AAV patients, MMF was associated with significant improvement in 18%, partial improvement in 26%, stabilization in 29%, and disease progression in 12%; adverse event dropouts totalled 15%. In SLE, the respective figures were 30, 22, 9, and 22%, with 17% adverse event dropouts. The most frequent side effects were gastrointestinal events ( n = 7) and infections ( n = 3). None was life-threatening and there were no deaths. Conclusions MMF, in the relatively low doses used, was safe and effective, stabilizing or improving AAV in 73% of patients and SLE in 61%. Further prospective randomized controlled trials with MMF in renal vasculitis and lupus nephritis are clearly warranted.