Lupus nephritis: treatment with mycophenolate mofetil

Kapitsinou, PP; Boletis, John; Skopouli, Fotini N.; Boki, Kyriaki; Moutsopoulos, H. M.

doi:10.1093/rheumatology/keh012

Cited by 96 publications

(71 citation statements)

References 16 publications

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“…Recently, MMF has been introduced in the treatment of SLE, with a significant therapeutic benefit and relative minor side effects [5,6,7,8,9,10,11,12]. Due to its potential therapeutic effects, it is previewed that in the near future, following head-to-head studies with conventional treatment, MMF administration will further increase and more SLE patients will be exposed to MMF.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, it has been introduced in the treatment of autoimmune diseases, including rheumatoid arthritis [2], systemic vasculitis [3], autoimmune hemolytic anemia [4] and SLE [5,6,7,8,9,10]. At this date, MMF is considered a safe and effective alternative therapy for renal and extrarenal manifestations in SLE not responding to a conventional treatment [11, 12].…”

Section: Introductionmentioning

confidence: 99%

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Hypersensitivity to Mycophenolate Mofetil in Systemic Lupus Erythematosus: Diagnostic Measures and Successful Desensitization

Szyper‐Kravitz

Sheinberg²,

Sidi³

et al. 2005

Int Arch Allergy Immunol

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Despite therapeutic advances in the treatment of systemic lupus erythematosus (SLE), several patients are still afflicted with severe and uncontrolled symptoms. Recently, mycophenolate mofetil (MMF) has been introduced in the treatment of SLE, with a significant therapeutic benefit, and minor side effects have been reported. Data on the adverse effects of MMF in SLE are lacking. We present an SLE patient who developed urticaria during MMF treatment. Rechallenge with MMF established the diagnosis of MMF-induced urticaria. As MMF was considered a necessary therapy, a desensitization protocol was devised, which successfully induced tolerance to MMF. This is the first published protocol for MMF desensitization, which induced tolerance in an SLE patient previously reacting with generalized urticaria.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hypersensitivity to Mycophenolate Mofetil in Systemic Lupus Erythematosus: Diagnostic Measures and Successful Desensitization

Szyper‐Kravitz

Sheinberg²,

Sidi³

et al. 2005

Int Arch Allergy Immunol

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“…Dooley et al reported improvements in proteinuria and renal function with MMF in 12 patients who were either resistant or relapsed after treatment with cyclophosphamide (17). In a retrospective study by Kapitsinou et al, 10 of 14 patients with proliferative LN who previously received cyclophosphamide were treated with MMF and went into complete remission, whereas the other 4 patients had partial remission with improved renal function and degree of proteinuria (19). In another study by Kingdon et al, MMF did not significantly reduce proteinuria in 13 patients who had relapsed despite conventional therapy (or were unable to receive alkylating agents); however, there was a reduction in the rate of decline of renal function along with improvement in serologic markers (18).…”

Section: Switch From Cyclophosphamide To Mmf or Vice Versamentioning

confidence: 99%

“…The most frequent side effects of MMF are infections and gastrointestinal intolerance, which occur in about one-third of all patients (19,21). These adverse effects are usually mild and discontinuation of the drug is often not required.…”

Section: Switch From Cyclophosphamide To Mmf or Vice Versamentioning

confidence: 99%

Lupus Nephritis

Kalloo

Aggarwal

Mohan

2013

Clinical Journal of the American Society of Nephrology

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SummaryLupus nephritis (LN) remains a major cause of ESRD and is associated with a >4-fold increase in mortality and significant morbidity in patients with lupus. The treatment of LN has evolved significantly over the past decade due to data from well conducted randomized controlled trials. We are currently in an era in which effective regimens exist in the form of induction and maintenance agents. Histopathologic classification of LN remains one of the main factors guiding therapy.

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“…Furthermore, this favorable profile has been observed in patients with renal impairment [5,6,7]. Although no randomized clinical trials have been performed in patients with CYC-refractory and relapsing LN, several reports and small cases series have shown that MF is highly effective and well tolerated and that it could be a good alternative in patients with LN [8,9,10]. Therefore, the role of MF in refractory and relapsing LN and its association with baseline clinical and analytical data is worth investigating.…”

Section: Introductionmentioning

confidence: 99%

Mycophenolate in Refractory and Relapsing Lupus Nephritis

Rivera

Mérida²,

Illescas³

et al. 2014

Am J Nephrol

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Background: Mycophenolate (MF) is effective as induction and maintenance treatment in patients with lupus nephritis (LN). This study evaluates the efficacy and safety of MF in patients with refractory and relapsing LN. Methods: Data were retrospectively obtained for 85 patients (35 refractory and 50 relapsing) from 11 nephrology departments in Spain. The primary endpoints were the incidence and cumulative number of renal responses and relapses and their relationship with baseline clinical and analytical data. The secondary endpoint was the appearance of side effects. Results: The main clinical and analytical variables were similar both in refractory and relapsing LN. Most of the patients had received cyclophosphamide, and all of them switched to MF. 74 patients (87%) achieved a response (69% partial, 31% complete). Age at starting MF, gender, pathological classification, body mass index, blood pressure, baseline renal function, and proteinuria were not associated with achieving response. After stopping MF, 3 of 19 patients (15.7%) relapsed, all at 6 months of follow-up. No differences were found between clinical and analytical variables and number of relapses. Side effects were unremarkable, except for 1 patient, who died of thrombocytopenia and ovarian hemorrhage. Conclusions: Switching to MF from other immunosuppressive treatments is effective and safe in refractory and relapsing LN.

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Lupus nephritis: treatment with mycophenolate mofetil

Abstract: MMF appears to be an efficacious and safe treatment in patients with proliferative forms of lupus nephritis who do not respond to or cannot tolerate conventional treatment. The efficacy of MMF in lupus membranous nephropathy remains unclear.

Cited by 96 publications

References 16 publications

Hypersensitivity to Mycophenolate Mofetil in Systemic Lupus Erythematosus: Diagnostic Measures and Successful Desensitization

Hypersensitivity to Mycophenolate Mofetil in Systemic Lupus Erythematosus: Diagnostic Measures and Successful Desensitization

Lupus Nephritis

Mycophenolate in Refractory and Relapsing Lupus Nephritis

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