Mycophenolate mofetil lupus nephritis

Moore RA, Derry S. (2006) Systematic review and meta-analysis of randomised trials and cohort studies of mycophenolate mofetil in lupus nephritis. Arthritis Res Ther 8 R182. 

Walsh M, James M, Jayne D, Tonelli M, Manns BJ, Hemmelgam BR. (2007) Mycophenolate mofetil for induction therapy of lupus nephritis A systematic review and meta-analysis. Clin J Am Soc Nephrol 2 968-975. 

There is no cure for SLE. Guillermo el al. (G16) found only 10 randomized controlled trials during the past 5 years, 5 for lupus nephritis and 5 for all SLE patients. Compared to conventional therapies for lupus nephritis, a monthly bolus with intravenous cyclophosphamide is more effective than a monthly bolus with methyl prednisolone, but has significant side effects (including amenorrhea, cervical dysplasia, avascular necrosis, and herpes zoster) in both groups (G14). In order to avoid these side effects, more recent therapies have been developed. However, neither plasmapheresis (Wl), intravenous immunoglobulin (B21), recombinant human DNase (rhDNase) (D3), nor mycophenolate mofetil (C14) was shown to be more effective than conventional therapy. However, some of these... 

Chan TM, Wong RWS, Lau CS, et al. Prolonged follow-up of patients with diffuse proliferative lupus nephritis treated with prednisolone and mycophenolate mofetil (abstract). J Am Soc Nephrol 2001 12 A1010. 

Contreras G, Pardo V, Leclercq B, et al. Maintenance therapy for proliferative forms of lupus nephritis A randomized clinical trial comparing quarterly intravenous cyclophosphamide versus oral mycophenolate mofetil or azathioprine (abstract). J Am Soc Nephrol 2002 13 15A. 

Systematic reviews Adverse events in five randomized controlled comparisons of mycophenolate mofetil and cyclophosphamide in the treatment of lupus nephritis in 638 patients have been analysed Infection rates, renal function, and gastrointestinal symptoms were not significantly different, except for leukopenia, which was more common with cyclophosphamide. 

Observational studies In a study of seven patients with lupus nephritis who failed on mycophenolate mofetil monotherapy, toxicity hmited the use of combination therapy with tacrolimus - - mycophenolate mofetil [84 ]. One patient achieved complete renal remission, and three achieved partial remission with reduced proteinuria. Four of seven patients stopped taking combination therapy because of diabetic ketoacidosis (n = 1), pneumonia ( = 1) and muscle pain (n = 2). Four patients had infectious complications, pneumonia (n = 2), herpes zoster (n = l), and septic arthritis ( = 1). There were no severe nephrotoxic adverse reactions, although there was a small increase in serum creatinine in two patients. 

Systematic reviews Adverse reactions to mycophenolate mofetil and cyclophosphamide in five randomized controlled comparisons in 638 patients with lupus nephritis have been reviewed Infections, renal... 

Kamanamool N, McEvoy M, Attia J, Ingsathit A, Ngamjanyaporn P, Thakkinstian A. Efficacy and adverse events of mycophenolate mofetil versus cyclophosphamide for induction therapy of lupus nephritis systematic review and meta-analysis. Medicine (Baltimore) 2010 89(4) 227-35. 

Yap DY, Yu X, Chen XM, Lu F, Chen N, Li XW, et al. Pilot 24 month study to compare mycophenolate mofetil and tacrolimus in the treatment of membranous lupus nephritis with nephrotic syndrome. Nephrol Carlt Vic May 2012 17(4) 352-7. PubMed PMID 22295934. Epub 2012/02/03. eng. 

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