A comparison study between mycophenolate mofetil and cyclophosphamide for treatment of proliferative lupus nephritis

Moon, Sung Jin; Kim, Dong Ki; Park, Sun Young; Chang, Jae Hyun; Kim, Hyun Wook; Lee, Jung Eun; Han, Seung Hyeok; Ko, Kwang Il; Kim, Dong Hyun; Kim, Chan Ho; Lee, Sang Won; Kim, Beom Suk; Kang, Shin Wook; Han, Dae Suk; Lee, Ho Yung; Park, Yong Beom; Lee, Soo Kon; Choi, Kyu Hun

Abstract

BACKGROUND/AIMS: Our study aimed to evaluate the efficacy of MMF as compared with intravenous cyclophosphamide as induction therapy for proliferative lupus nephritis in Koreans.
METHODS
Forty-three patients who were diagnosed with proliferative lupus nephritis (WHO Class III and IV) between Jan 2000 and Dec 2006 were included in this study. Nineteen patients were treated with oral MMF (initial dose: 1.0 g/day and then it was increased to 2.0 g/day) and 24 patients were treated with 0.75-1.0 g/m2 of monthly intravenous cyclophosphamide (CP) followed by subsequent treatment with oral corticosteroid (initial dose 1 mg/kg/day and then it was slowly tapered down) for 6 months. The demographic and laboratory findings, the response rate and the adverse events were reviewed retrospectively and these were compared between the two groups.
RESULTS
A complete response occurred in 7 out of the 19 patients (36.8%) treated with MMF and in 8 out of the 24 patients (33.3%) treated with CP, and the difference was not significantly different between the two groups (p=0.66). A partial response was achieved in 52.6% and 45.8%, respectively. There were no significant differences of the laboratory findings such as serum albumin, C3, C4, the urine protein/creatinine ratio and serum creatinine after treatment for 6 months. In addition, both groups had similar rates of adverse events.
CONCLUSIONS
Our study showed that for the treatment of lupus nephritis, MMF was as effective as IV cyclophosphamide with similar adverse events. This finding suggests that MMF could be an alternative treatment for active lupus nephritis as induction therapy.