Mycophenolate mofetil as treatment for lupus nephritis

Abstract

Advances in immunosuppressive treatment and supportive care over the past few decades have led to improved clinical outcomes in patients with severe lupus nephritis. The management of severe proliferative lupus nephritis can be divided into an initial induction phase followed by a prolonged maintenance phase. Combined use of corticosteroid and cyclophosphamide has been the standard induction therapy, although a significant proportion of patients develop treatment-related complications such as infection and gonadal failure. While there is general agreement on the immunosuppressive regimen for induction treatment, there is marked variation with regard to maintenance immunosuppressive regimens. The latter is consequent to a paucity of data, since a big sample size and prolonged follow-up is required for clinical studies that investigate maintenance treatment, in view of the marked heterogeneity in patient characteristics and individual differences in the propensity for relapse. Nevertheless, there is accumulating evidence that a combination of corticosteroid and mycophenolate mofetil can be adopted as effective and well-tolerated treatment both for induction and for long-term maintenance in lupus nephritis. Favourable long-term prognosis can be ensured provided that effective treatment can be instituted early, before irreversible renal parenchymal damage is established. ©Asia Pacific League of Associations for Rheumatology.