Mycophenolate mofetil in the treatment of Chinese patients with lupus nephritis

Zhang, Haitao; Zhou, Mingda; Han, Xiaoyan; Yang, Yang; Yu, Xinran

doi:10.1097/md.0000000000021121

Cited by 11 publications

(6 citation statements)

References 26 publications

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“…Lupus nephritis can manifest as hematuria, albuminuria, or acute or chronic kidney injury. [15][16][17][18] In recent years, the prognosis of LN has been substantially improved, and the risk of mortality has been greatly reduced by induction remission and maintenance therapy. 19 At present, the application of glucocorticoids and immunosuppressants is generally accepted in the current guidelines globally.…”

Section: Discussionmentioning

confidence: 99%

Infection profile and risk factors for mortality in patients with end-stage renal disease attributable to systemic lupus erythematosus: a two-center integrated study

et al. 2022

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Objective Renal impairment is a significant complication of systemic lupus erythematosus (SLE). Additionally, infection in patients with end-stage renal disease (ESRD) attributable to SLE is common, and it increases the risk of mortality. This study explored the infection profile and risk factors for mortality in patients with ESRD attributable to SLE. Methods In this retrospective, observational study of 125 hospitalized patients, demographic, clinical, laboratory, treatment, and prognosis data were retrieved and analyzed. Results The 125 cases included 98 pulmonary infections (78.4%), 14 urinary infections (11.2%), and 13 intestinal infections (10.4%). Twenty-six patients died within 1 month after enrollment. Univariate Cox regression and Kaplan–Meier analyses revealed several possible indicators potentially influencing patient survival. Furthermore, multivariate Cox regression analysis identified a higher SLE Disease Activity Index-2000 score, recent higher-dose glucocorticoid use, hypertension, and catheter indwelling as risk factors for higher mortality. Conclusions Infections were common in patients with advanced SLE and ESRD, and several risk factors might increase the risk of mortality. Once infection is identified, empiric antibiotics should be initiated immediately, and subsequent antibiotics should be applied per the results of drug sensitivity testing to clear the infection.

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Section: Discussionmentioning

confidence: 99%

Infection profile and risk factors for mortality in patients with end-stage renal disease attributable to systemic lupus erythematosus: a two-center integrated study

et al. 2022

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“…The finding of superiority of MMF use for lupus nephritis induction in minority groups such as African Americans and Hispanics underscores the importance of precision medicine and inclusivity in clinical trial involvement [8]. The standard dosing of MMF for lupus nephritis induction is 1.5 g twice a day, with the Chinese literature suggesting MMF 1 g twice a day is sufficient for their population [36]. For lupus nephritis maintenance, MMF is the preferred agent over azathioprine [26,37], and 1 g twice a day has been used with debates ongoing about the length of therapy, now approaching 3-5 years.…”

Section: Mycophenolate Mofetilmentioning

confidence: 99%

New guidelines and therapeutic updates for the management of lupus nephritis

Desai,

Ahdoot,

Malik

et al. 2024

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of review Systemic lupus erythematosus (SLE) can be a devastating condition, striking young patients often in their prime reproductive years. Lupus nephritis is a common and serious complication occurring in roughly 50% of SLE cases, indicating a high likelihood of disease progression, morbidity, and mortality. As the early trials of steroid therapy, and later cyclophosphamide (CYC), therapeutic changes had been stagnant. Then came the introduction of mycophenolate mofetil (MMF) in the 2000s. After the Aspreva Lupus Management Study, there had been a dearth of trials showing positive therapy results. Since 2020, new studies have emerged for lupus nephritis involving the use of anti-BLYS agents, novel calcineurin inhibitors, CD20 blockade, and antiinterferon agents. Nephrology and rheumatology society guidelines in the United States and across the world are still catching up. Recent findings Although therapeutic guidelines are being developed, updates that have come through have focused on improved diagnostic and monitoring guidelines. One theme is the recommendation of increasingly tight proteinuria control and firmer guidelines for the rapid induction of remission. The reality of multitarget therapy and the expectation of rapid induction for a more complete remission are being widely recognized. Summary The need for more complete and more rapid induction and control of lupus nephritis is undisputed according to the evidence and guidelines, and the medications to achieve this are growing at a rate not seen over the prior two decades. What remains is a stepwise approach to recognize how to best optimize therapy. Based on available evidence, an algorithm for induction and maintenance treatment of lupus nephritis used by the University of California Irvine Lupus Nephritis clinic, is recommended.

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“…Indeed, beyond the realm of autoantibodies and immune complex deposition, a compelling body of evidence underscores the pivotal role of cytokines in the intricate tapestry of SLE pathogenesis [12] . Among these cytokines, the interleukin-6 (IL-6)/IL-6 receptor (IL-6R) signaling has garnered signi cant attention due to its robust link with LN activity in individuals with SLE [13,14] . In the context of LN, the primary source of IL-6 are the in ltrating in ammatory cells within kidneys, predominantly macrophages and monocytes [15] .…”

Section: Introductionmentioning

confidence: 99%

Aberrant expression of C1q, IL-6 and β-catenin in class VI lupus nephritis

Xue,

Min,

Zhu

et al. 2023

Preprint

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Background: complement component C1q, interleukin-6 (IL-6) and β-catenin have been implicated in the pathogenesis of lupus nephritis (LN). However, their correlation with the pathological progression and type of LN remain unclear. Methods: the concentrations of C1q, IL-6 and β-catenin were evaluated in plasma, urine and kidney tissues in LN patients, non-LN systemic lupus erythematosus (SLEn) patients, and healthy cohorts, as well as C57BL/6, IL-6-/-, MRL-Fas/lpr and MRL-Fas/lprIL-6-/- mice. Results: more abundant plasma C1q, IL-6 and urine C1q proteins were determined in LN and SLEn patients compared to healthy cohorts. Of note, the concentration of IL-6 and β-catenin in both plasma and urine, and plasma C1q was even higher in LN patients relative to SLEn subjects. Moreover, positive correlations were determined for C1q and β-catenin proteins between plasma and urine in LN patients. Of importance, both plasma and urine β-catenin, and urine IL-6 were significantly increased in patients with class VI LN patients relative to those who suffered from class I LN. Immunohistochemical study further uncovered that the abundant IL-6 and β-catenin proteins were deposited in both renal glomeruli and tubules, while the C1q was only found in renal glomeruli of patients with class IV LN. Consistent with the clinical findings, experimental studies in MRL-Fas/lprIL-6-/- mice also showed a decreased β-catenin in urine, C1q and β-catenin in kidney tissues of MRL-Fas/lprIL-6-/- mice compared with MRL-Fas/lpr mice. Interestingly, mice with deficiency of IL-6 exhibited less degrees of proteinuria and histological lesions, and reduced serum anti-double-stranded DNA (anti-dsDNA) antibody and sizes of spleen and inguinal node, as compared with MRL-Fas/lpr and C57/BL6 control mice. Conclusions: these data suggest a strong correlation among IL-6, C1q and β-catenin in the pathogenesis of type VI LN in SLE patients, indicating that they may be valuable biomarkers for nephrologists to guide treatment and predict prognosis among these patients.

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Mycophenolate mofetil in the treatment of Chinese patients with lupus nephritis

Abstract: Supplemental Digital Content is available in the text

Cited by 11 publications

References 26 publications

Infection profile and risk factors for mortality in patients with end-stage renal disease attributable to systemic lupus erythematosus: a two-center integrated study

Infection profile and risk factors for mortality in patients with end-stage renal disease attributable to systemic lupus erythematosus: a two-center integrated study

New guidelines and therapeutic updates for the management of lupus nephritis

Aberrant expression of C1q, IL-6 and β-catenin in class VI lupus nephritis

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