Switching Treatment Between Mycophenolate Mofetil and Azathioprine in Lupus Patients: Indications and Outcomes

Abstract

Switching from AZA to MMF is most often due to AZA failure, whereas switching from MMF to AZA is mostly due to side effects and pregnancy. When the reason for the switch was drug failure, improvement in disease activity occurred and there was a reduction of steroid dose after 6 months. When the reason for switching was something other than drug failure, there was no deterioration in global disease activity. Switching for side effects usually resulted in elimination of the side effect.

Impact of Smoking, Steroid Use and Immunosuppression on Anti-dsDNA Antibodies in Systemic Lupus Erythematosus

“…In this cohort, 37.82% of patients received azathioprine, 30.25% mycophenolate mofetil, 4.20% methotrexate, and 24.37% belimumab, with 71.42% on hydroxychloroquine. These frequencies are largely consistent with existing data on SLE treatment patterns, where AZA and MMF are among the most commonly used immunosuppressants [ 25 ]. The proportion of patients receiving belimumab is comparable to that found in recent studies investigating biologic use in SLE [ 26 ].…”

Impact of Smoking, Steroid Use and Immunosuppression on Anti-dsDNA Antibodies in Systemic Lupus Erythematosus

“…In this cohort, 37.82% of patients received azathioprine, 30.25% mycophenolate mofetil, 4.20% methotrexate, and 24.37% belimumab, with 71.42% on hydroxychloroquine. These frequencies are largely consistent with existing data on SLE treatment patterns, where AZA and MMF are among the most commonly used immunosuppressants [ 25 ]. The proportion of patients receiving belimumab is comparable to that found in recent studies investigating biologic use in SLE [ 26 ].…”

Azathioprine during pregnancy in systemic lupus erythematosus patients is not associated with poor fetal outcome

“…However, the strengths of our study are that we evaluated the effect of azathioprine only in patients with lupus and that we studied the impact of disease activity on fetal outcome, something that was not analyzed by other authors [4,7]. A recent study recommends that pregnant patients with lupus and pre-treated with mycophenolate mofetil should switch to azathioprine [29], especially in order to prevent relapse in lupus nephritis.…”

Premature rupture of membranes – A cause of foetal complications among lupus: A cohort study, systematic review and meta-analysis

“…52,63,67,68 One study, among the very few that specifically looked for PROM as an adverse pregnancy outcome, did not find this event to be associated with azathioprine use. 52 However, this drug is associated with a higher risk of infections, [69][70][71][72] which is classically associated with PROM. 23,73,74 In this cohort, we found azathioprine to be associated with PROM/PPROM; due to its potential association with maternal infections, we performed an analysis including a control for its use during pregnancy and observed that the association between azathioprine and PROM was probably due to the increased propensity of maternal infections besides SLE activity.…”

Impact of Smoking, Steroid Use and Immunosuppression on Anti-dsDNA Antibodies in Systemic Lupus Erythematosus

“…In this cohort, 37.82% of patients received azathioprine, 30.25% mycophenolate mofetil, 4.20% methotrexate, and 24.37% belimumab, with 71.42% on hydroxychloroquine. These frequencies are largely consistent with existing data on SLE treatment patterns, where AZA and MMF are among the most commonly used immunosuppressants [ 25 ]. The proportion of patients receiving belimumab is comparable to that found in recent studies investigating biologic use in SLE [ 26 ].…”

Azathioprine during pregnancy in systemic lupus erythematosus patients is not associated with poor fetal outcome

“…However, the strengths of our study are that we evaluated the effect of azathioprine only in patients with lupus and that we studied the impact of disease activity on fetal outcome, something that was not analyzed by other authors [4,7]. A recent study recommends that pregnant patients with lupus and pre-treated with mycophenolate mofetil should switch to azathioprine [29], especially in order to prevent relapse in lupus nephritis.…”

Premature rupture of membranes – A cause of foetal complications among lupus: A cohort study, systematic review and meta-analysis

“…52,63,67,68 One study, among the very few that specifically looked for PROM as an adverse pregnancy outcome, did not find this event to be associated with azathioprine use. 52 However, this drug is associated with a higher risk of infections, [69][70][71][72] which is classically associated with PROM. 23,73,74 In this cohort, we found azathioprine to be associated with PROM/PPROM; due to its potential association with maternal infections, we performed an analysis including a control for its use during pregnancy and observed that the association between azathioprine and PROM was probably due to the increased propensity of maternal infections besides SLE activity.…”

Impact of Smoking, Steroid Use and Immunosuppression on Anti-dsDNA Antibodies in Systemic Lupus Erythematosus

“…In this cohort, 37.82% of patients received azathioprine, 30.25% mycophenolate mofetil, 4.20% methotrexate, and 24.37% belimumab, with 71.42% on hydroxychloroquine. These frequencies are largely consistent with existing data on SLE treatment patterns, where AZA and MMF are among the most commonly used immunosuppressants [ 25 ]. The proportion of patients receiving belimumab is comparable to that found in recent studies investigating biologic use in SLE [ 26 ].…”

Azathioprine during pregnancy in systemic lupus erythematosus patients is not associated with poor fetal outcome

“…However, the strengths of our study are that we evaluated the effect of azathioprine only in patients with lupus and that we studied the impact of disease activity on fetal outcome, something that was not analyzed by other authors [4,7]. A recent study recommends that pregnant patients with lupus and pre-treated with mycophenolate mofetil should switch to azathioprine [29], especially in order to prevent relapse in lupus nephritis.…”

Premature rupture of membranes – A cause of foetal complications among lupus: A cohort study, systematic review and meta-analysis

“…52,63,67,68 One study, among the very few that specifically looked for PROM as an adverse pregnancy outcome, did not find this event to be associated with azathioprine use. 52 However, this drug is associated with a higher risk of infections, [69][70][71][72] which is classically associated with PROM. 23,73,74 In this cohort, we found azathioprine to be associated with PROM/PPROM; due to its potential association with maternal infections, we performed an analysis including a control for its use during pregnancy and observed that the association between azathioprine and PROM was probably due to the increased propensity of maternal infections besides SLE activity.…”