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Article: Mycophenolate mofetil in lupus glomerulonephritis

TitleMycophenolate mofetil in lupus glomerulonephritis
Authors
KeywordsCyclophosphamide (CYC)
Cytotoxic
Immunosuppressive
Lupus nephritis
Proliferative
Renal
Issue Date2002
PublisherWB Saunders Co. The Journal's web site is located at http://www.elsevier.com/locate/ajkd
Citation
American Journal Of Kidney Diseases, 2002, v. 40 n. 3, p. 447-457 How to Cite?
AbstractThe optimal treatment of severe lupus nephritis is unclear. Regimens consisting of steroid and cyclophosphamide (CYC) appear to be most effective. However, up to 15% of patients are refractory to CYC treatment, and 30% to 50% of patients still develop end-stage renal disease. Moreover, infection and gonadal toxicity are major concerns of CYC use in patients of the reproductive age. More effective, but less toxic, regimens are needed. Mycophenolate mofetil (MMF) is a new immunosuppressive agent that selectively inhibits activated lymphocytes and renal mesangial cells. Experience with MMF in solid-organ transplantation has shown the safety of this drug and its superiority over azathioprine (AZA) in the prevention of acute graft rejection. Data from experimental models of immune-mediated glomerulonephritis, particularly lupus nephritis, have shown that MMF ameliorates autoimmune phenomena, retards renal damage, and improves outcome. Although the use of MMF in lupus nephritis is still in its preliminary stage, uncontrolled experience has confirmed its efficacy in patients with serious disease recalcitrant to conventional cytotoxic agents. Controlled studies, albeit small and lacking statistical power, have shown that MMF is as effective as CYC in the induction of renal remission in the short term. With the current dosage used in systemic lupus erythematosus, MMF appears to be well tolerated, with no serious toxicities reported. Significantly less ovarian toxicity compared with CYC is particularly attractive for the consideration of MMF in lupus nephritis. However, the lack of long-term efficacy data and comparative studies with standard CYC regimens is the major deterrent for the first-line use of MMF in high-risk patients at this juncture. © 2002 by the National Kidney Foundation, Inc.
Persistent Identifierhttp://hdl.handle.net/10722/77936
ISSN
2015 Impact Factor: 6.269
2015 SCImago Journal Rankings: 2.313
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorMok, CCen_HK
dc.contributor.authorLai, KNen_HK
dc.date.accessioned2010-09-06T07:37:22Z-
dc.date.available2010-09-06T07:37:22Z-
dc.date.issued2002en_HK
dc.identifier.citationAmerican Journal Of Kidney Diseases, 2002, v. 40 n. 3, p. 447-457en_HK
dc.identifier.issn0272-6386en_HK
dc.identifier.urihttp://hdl.handle.net/10722/77936-
dc.description.abstractThe optimal treatment of severe lupus nephritis is unclear. Regimens consisting of steroid and cyclophosphamide (CYC) appear to be most effective. However, up to 15% of patients are refractory to CYC treatment, and 30% to 50% of patients still develop end-stage renal disease. Moreover, infection and gonadal toxicity are major concerns of CYC use in patients of the reproductive age. More effective, but less toxic, regimens are needed. Mycophenolate mofetil (MMF) is a new immunosuppressive agent that selectively inhibits activated lymphocytes and renal mesangial cells. Experience with MMF in solid-organ transplantation has shown the safety of this drug and its superiority over azathioprine (AZA) in the prevention of acute graft rejection. Data from experimental models of immune-mediated glomerulonephritis, particularly lupus nephritis, have shown that MMF ameliorates autoimmune phenomena, retards renal damage, and improves outcome. Although the use of MMF in lupus nephritis is still in its preliminary stage, uncontrolled experience has confirmed its efficacy in patients with serious disease recalcitrant to conventional cytotoxic agents. Controlled studies, albeit small and lacking statistical power, have shown that MMF is as effective as CYC in the induction of renal remission in the short term. With the current dosage used in systemic lupus erythematosus, MMF appears to be well tolerated, with no serious toxicities reported. Significantly less ovarian toxicity compared with CYC is particularly attractive for the consideration of MMF in lupus nephritis. However, the lack of long-term efficacy data and comparative studies with standard CYC regimens is the major deterrent for the first-line use of MMF in high-risk patients at this juncture. © 2002 by the National Kidney Foundation, Inc.en_HK
dc.languageengen_HK
dc.publisherWB Saunders Co. The Journal's web site is located at http://www.elsevier.com/locate/ajkden_HK
dc.relation.ispartofAmerican Journal of Kidney Diseasesen_HK
dc.subjectCyclophosphamide (CYC)en_HK
dc.subjectCytotoxicen_HK
dc.subjectImmunosuppressiveen_HK
dc.subjectLupus nephritisen_HK
dc.subjectProliferativeen_HK
dc.subjectRenalen_HK
dc.titleMycophenolate mofetil in lupus glomerulonephritisen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0272-6386&volume=40&spage=447&epage=457&date=2002&atitle=Mycophenolate+Mofetil+in+Lupus+Glomerulonephritisen_HK
dc.identifier.emailLai, KN: knlai@hku.hken_HK
dc.identifier.authorityLai, KN=rp00324en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1053/ajkd.2002.34882en_HK
dc.identifier.pmid12200794-
dc.identifier.scopuseid_2-s2.0-0036724303en_HK
dc.identifier.hkuros81764en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0036724303&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume40en_HK
dc.identifier.issue3en_HK
dc.identifier.spage447en_HK
dc.identifier.epage457en_HK
dc.identifier.isiWOS:000177796000002-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridMok, CC=34668219600en_HK
dc.identifier.scopusauthoridLai, KN=7402135706en_HK

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