Long-Term Renal and Fertility Outcomes after Lupus Nephritis Induction Therapy

Abstract

Background: Lupus nephritis (LN) may progress to loss of kidney function. Cyclophosphamide (CYC) and Mycophenolate Mofetil (MMF) are commonly used for induction therapy in LN. This study aimed to compare the long-term renal and fertility outcomes of CYC and MMF induction therapy in LN Egyptian patients. Methods: A retrospective comparative study included 184 patients with LN class III and IV; 132 received CYC induction, and 52 received MMF. All their data were revised including history, examination, results of 1st renal biopsy, immunological markers, response to induction, relapse, maintenance therapy, and effects on renal functions and fertility. Results: After 6 months of induction, remission was significantly higher in the MMF group (71.15%), than in the CYC group (37.12%) (p˂0.05). There was a significant reduction in 24-hour urine proteins mean±SD (gm/day) in the CYC group from (4.5±2.2) to (2.6±0.6) (p˂0.05), and in the MMF group from (5.4±2.8) to (3.3±0.8) (p˂0.05). For maintenance, (61.36%) of the CYC induction group used steroid + Azathioprine (AZA), while (80.77%) of the MMF group used steroid + MMF (p>0.05). After long-term follow-up, complications occurred more in the CYC group (55%), compared to (34.6%) in the MMF group, with a statistically significant difference (p˂0.05). But there was no statistically significant difference between the 2 groups as regards the renal outcome, or fertility (p>0.05). Conclusions: MMF has a better remission rate in LN induction than CYC, but after long-term follow-up for maintenance therapy with steroid plus (AZA versus MMF), the renal and fertility outcomes were comparable in both groups.