Efficacy and Tolerability of Mycophenolate Mofetil in Patients with Lupus Nephritis / 대한류마티스학회지

ABSTRACT

OBJECTIVE: To determine the therapeutic effect of mycophenolate mofetil (MMF) and the adverse effects associated with MMF in patients with lupus nephritis. METHODS: We studied 51 patients with lupus nephritis, who had received MMF for more than 3 months. The efficacy was assessed as renal profiles, SLE disease activity index (SLEDAI), serum cytokine levels and oral corticosteroid dose. The adverse effects were evaluated by medical records and interview of each patient. Serum cytokine levels of IL-10, IFN-alpha and IFN-gamma were determined by sandwich ELISA at starting MMF and at 12 months after MMF therapy. RESULTS: MMF treatment resulted in complete remission 52.9%, partial remission 25.5% and treatment failure 21.6%. There was no difference of MMF efficacy between WHO class IV and V in 32 patients with biopsy-proven nephritis. The renal profiles and parameters for disease activity were improved, as assessed by increased serum albumin and C3 level, decreased proteinuria, cyturia, ESR, SLEDAI and oral corticosteroid doses. Serum IL-10 decreased after MMF therapy in class IV group, but not in class V group. Serum IFN-alpha, IFN-gamma level and IFN-gamma/IL-10 ratio also tended to decrease after MMF therapy. GI troubles including dyspepsia, nausea, vomiting and diarrhea were the most common adverse effects of MMF as 54.9%, followed by hair loss, leukopenia, anemia, infection, but there was no serious adverse effect. CONCLUSION: MMF is an effective and well tolerable immunosuppressant for both class IV and V lupus nephritis, even not responding or intolerable to conventional immunosuppressive therapy.