Chapter

Mycophenolate mofetil as treatment in lupus nephritis

Daniel Tak Mao Chan

in Lupus Nephritis

Second edition

Published on behalf of Oxford University Press

Published in print November 2010 | ISBN: 9780199568055
Published online November 2012 | e-ISBN: 9780191753374 | DOI: http://dx.doi.org/10.1093/med/9780199568055.003.0010

Series: Oxford Clinical Nephrology Series

Mycophenolate mofetil as treatment in lupus nephritis

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The management of severe lupus nephritis entails considerations of treatment efficacy and the prevention and treatment of disease-related complications and drug-induced toxicities, which can present immediately or emerge during long-term follow-up. The heterogeneity in clinical course and responses to treatment presents additional challenges. Accumulating data over the past decade have substantiated the important role of MMF as first-line treatment of diffuse or focal proliferative lupus nephritis. High response rates have been observed in patients treated with corticosteroid and MMF for remission induction, especially in Chinese and Caucasian populations, and the available data from Chinese patients show that the favorable early response is associated with low morbidity, mortality, and rate of renal failure during follow-up. Although the response rates to this induction treatment appeared slightly lower in African Americans and Hispanics, it is in these patients that treatment with MMF has been shown to confer a better efficacy than induction treatment with intravenous CTX. At appropriate dosage, MMF treatment is associated with fewer adverse effects compared to CTX, but careful attention to patient characteristics, including ethnicity, is required to ensure optimization of the efficacy–risk profile during immunosuppressive treatment. Further studies are required to examine the role and optimal dose of MMF in the treatment of crescentic lupus nephritis and membranous lupus nephritis, as well as the impact of MMF treatment in children with lupus nephritis, in comparison with other available therapies. In contrast to the definitive conclusions on MMF as an induction agent, there is considerable uncertainty on the comparative advantage of MMF against azathioprine when given as maintenance immunosuppression. It is intuitive that too rapid tapering or early discontinuation of MMF could precipitate disease flares. The experience to date suggests that the dose of MMF should probably not be reduced by more than 25% after the first 6 months, and that it is advisable to continue treatment for at least 12–18 months, in order to secure a sustained disease response. Effective and safe immunosuppressive treatment plays a critical role in preserving nephron mass and renal reserve. The importance of adjunctive treatments, such as the control of hypertension, the suppression of proteinuria, and the prevention of systemic complications, in ensuring optimal long-term outcomes cannot be overemphasized.

Chapter.  8925 words.  Illustrated.

Subjects: Nephrology

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