The Efficacy of Mycophenolate Mofetil on Treatment of New Lupus Nephritis

Introduction: Mycophenolate mofetil (MMF) is a new immunouppressive agenty
that selectively inhibits activated lymphoctes and renal mesangial cells.
Experience with MMF in solid – organ transplantation has shown the safety of
this drug and its superiority over azathioprine (AZA) in the prevention of acute
graft rejection. In this study, treatment improvement of lupus nephritis is
investigated, using Mycophenolate Mofetil.
Methods: We performed a nonrandomized clinical trial in 12 patients with
various forms of lupus nephritis (two patients with class V, five patients with
class III, four patients with class IV) were treated with oral MMF at a dose of
2gr/day and for a mean of 5.38 months range 4-6).
All patients were new cases and received concomitant prednisolone. We started
treatment with MMF in all new cases of lupus nephritis. Treatment outcome was
monitored through assessment of systemic Lupus Erythematosus Disease Activity
Index (SLEDAI) score, renal function, proteinuria and serologic markers such as
serum complement and anti dsDNA antibodies. Data were analyzed using Kruscal
wallis and Willcoxon statistical tests.
Results: While serum createnine remained normal (in 8 patients) or increased less
than 33% (in 3 patients). Proteinuria was decreased in 9 cases and Antids DNA
was negative in 5 cases. Complete improvement and nelatine improvement of the
patients were 36.4% and 45.6%, respectively.
Conclusion: Mycophenolate mofetil may represent a valuable alternative to
traditional cytotoxic agents for treatment of nephritis. MMF appeared to be
effective in controlling serologic disease activity in SLE. Adverse events such as
infections may limit its use and remain a concern. MMF should be considered in
the treatment of both new cases and resistant lupus nephritis. Controlled clinical
trials are required to confirm these findings.