Myocophenolate mofetil in the treatment of systemic lupus erythematosus


Authors: R. Svobodová;  M. Sokalská Jurkiewicz;  J. Hořínková
Authors‘ workplace: Revmatologický ústav Praha
Published in: Čes. Revmatol., 21, 2013, No. 3, p. 140-146.
Category: Review and Case Report

Overview

Systemic lupus erythematosus is a systemic autoimmune disease with multiple organ manifestations and serologic abnormalities. The spectrum of clinical manifestations is wide, varying from mild symptoms to potentially lethal conditions with irreversible organ damage. Organ involvement determines the morbidity and mortality of patients and the type of therapy. The most common involvement includes lupus nephritis, which occurs in 15–60% of patients, and leads to chronic renal failure in up to 47% of patients. Currently, a two-stage treatment of lupus nephritis is recommended: an intensive induction phase to induce remission followed by the maintenance phase to maintain remission.

In a case report of a female patient with systemic lupus erythematosus with multiple organ involvement – (lupus nephritis, vasculitis, ocular and hematologic involvement, pericarditis) and high antibody activity (positive antinuclear antibodies, anti-dsDNA, anti-C1q, ANCA and anti-nucleosome antibodies), the issues of therapy associated with intolerance and adverse effects of standard treatment are discussed. In recent years, mycophenolate mofetil has been demonstrated to play a significant role in the treatment of lupus nephritis in patients with systemic lupus erythematosus. In many cases mycophenolate mofetil can successfully replace the existing therapy.

Key words:
Systemic lupus erythematosus, lupus nephritis, mycophenolate mofetil


Sources

1. Yokoyama H, Okuyama H, Yamaya H. Clinicopathological insights into lupus glomerulonephritis in Japanese and Asians. Clin Exp Nephrol 2011;15:321-30.

2. Seligman VA, Lum RF, Olson JL et al. Demographic differences in the development of lupus nephritis: A retrospective analysis. Am J Med 2002;112:726-9.

3. Bastian HM, Roseman JM, McGwin G Jr et al. LUMINA Study Group. LUpus in MInority populations: NAture vs nurture: Systemic lupus erythematosus in three ethnic groups. XII. Risk factors for lupus nephritis after diagnosis. Lupus 2002;11:152-60.

4. Contreras G, Pardo V, Cely C et al. Factors associated with poor outcomes in patients with lupus nephritis. Lupus 2005;14:890-5.

5. Dooley MA, Falk RJ. Human clinical trials in lupus nephritis. Semin Nephrol 2007;27:115-27.

6. Moroni G, Quaglini S, Maccario M et al. „Nephritis flares“ are predictors of bad long-term renal outcome in lupus nephritis. Kidney Int 1996;50:2047-53.

7. Pablos JL, Gutierrez-Millet V, Gomez-Reino JJ. Remission of lupus nephritis with cyclophosphamide and late relapses following therapy withdrawal. Scand J Rheumatol 1994;23:142-4.

8. Hebert LA, Dillon JJ, Middendorf DF et al. Relationship between appearance of urinary red blood cell/white blood cell casts and the onset of renal relapse in systemic lupus erythematosus. Am J Kidney Dis 1995;26:432-8.

9. Ciruelo E, de la Cruz J, López I et al. Cumulative rate of relapse of lupus nephritis after successful treatment with cyclophosphamide. Arthritis Rheum 1996;39:2028-34.

10. Illei GG, Takada K, Parkin D et al. renal flares are common in patients with severe proliferative lupus nephritis treated with pulse immunosuppressive therapy: Long-term follow up of a cohort of 145 patients participating in randomized controlled studies. Arthritis rheum 2002;46:995-1002.

11. Austin HA 3rd, Klippel JH, Balow JE et al. Therapy of lupus nephritis. Controlled trial of prednison and cytotoxic drugs. N Engl J Med 1986;314:614-9.

12. Steinberg AD, Steinberg SC. Long-term preservation of renal function in patients with lupus nephritis receiving treatment that includes cyclophosphamide versus those treated with prednisone only. Arthritis Rheum 1991;34:945-50.

13. Boumpas DT, Austin HA 3rd, Vaughan EM et al. Controlled trial of pulse methyl-prednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis. Lancet 1992;340:741-5.

14. Gourley MF, Austin HA 3rd, Scott D et al. Methylprednisolone and cyclophosphamide, alone or in combination, in patients with lupus nephritis. A randomized, controlled trial. Ann Intern Med 1996;125:549-57.

15. Boumpas DT, Austin 3rd, Vaughan EM et al. Risk for sustained amenorrhea in patients with systemic lupus erythematosus receiving intermittent pulse cyclophosphamide therapy. Ann Intern med 1993;119:366-9.

16. González-Rivera TC, McCune J. Mycophenolate mofetil for the induction and maintenance treatment of lupus nephritis. Immunotherapy 2011;3:1431-40.

17. Houssiau FA, Vasconcelos C, D´Cruz D et al. Immunosuppressive therapy in lupus nephritis: the Euro-Lupus Nephritis Trial, a randomized trial of low-dose versus high-dose intravenous cyclophosphamide. Arthritis Rheum 2002;46:2121-31.

18. Houssiau FA, Vasconcelos C, D´Cruz D et al. Early response to immunosuppressive therapy predicts good renal outcome in lupus nephritis: lessons from long-term followup of patients in the Euro-Lupus Nephritis Trial. Arthritis Rheum 2004;50:3934-40.

19. Contreras G, Pardo V, Leclercq B et al. Sequential therapies for proliferative lupus nephritis. N Engl J Med 2004;350:971-80.

20. Chan TM, Li FK, Tang CS et al. Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. N Engl J Med 2000;343:1156-1162.

21. Chan TM, Tse KC, Tang CS et al. Long-term study of mycophenolate mofetil as continuous induction and maintenance treatment for diffuse proliferative lupus nephritis. J Am Soc Nephrol 2005;16:1076-84.

22. Appel GB, Contreras G, Dooley MA et al. Mycophenolate Mofetil versus Cyclophasphamide for Induction Treatment of Lupus Nephritis. J Am Soc Nephrol 2009;20:1103-12.

23. Houssiau FA, D´Cruz D, sangle S et al. MAINTAIN Nephritis Trial Group: Azathioprine versus mycophenolate mofetil for long-term immunosuppression in lupus nephritis: Result from the MAINTAIN Nephritis Trial. Ann Rheum Dis 2010;69:2083-9.

24. Dooley MA, Jayne D, Ginzler EM et al.; ALMS Group: Mycophenolate versus azathioprine as maintenance therapy for lupus nephritis. N Engl J Med 2011;365:1886-95.

25. Merrill J, Buyon J, Furie R et al. Assessment of flares in lupus patiens enrolled in a phase II/III study of rituximab (EXPLORER). Lupus 2011;20:709-16.

26. Rovin BH, Furie R, Latinis K, et al. LUNAR Investigator Group. Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: the lupus nephritis assessment with rituximab study. Arthritis Rheum. 2012;64:1215-26.

27. Weidenbusch M, Römmele C, Schröttle A, Anders HJ. Beyond the LUNAR trial. Efficacy of rituximab in refraktory lupus nephritis. Nephrol Dial Transplant 2012;Jul 3. [Epub ahaed of print]

28. Tesar V, Hruskova Z. Recent news in the treatment of lupus nephritis. 2012 Aug;103:235-51.

29. Lenz O, Waheed AA, Baig A et al. Lupus Nephritis: Maintenance Therapy for Lupus Nephritis – Do We Now Have a Plan? Clin J Am Nephrol 8:2012 ePress.

30. Mok CC. Prognostic factors in lupus nephritis. Lupus 2005;14:39-44.

31. Tesař V. Novinky v léčbě proliferativní lupusové nefritidy. Novinky v nefrologii. Září 2010; Ročník VIII, číslo 4.

32. Hogan J, Schwenk M, Radhakrishanan J. Should mycophenolate mofetil replace cyclophosphamide as first-line therapy for severe lupus nephritis? Kidney International advance online publication, 30 May 2012)

33. Han F, Liu G, Zhang X et al. Effects of mycophenolate mofetil combined with corticosteroids for induction therapy of microscopic polyangiitis. Am J Nephrol 2011;33:185-92.

34. Du Y, Hou L, Zhao C et al. Treatment of children with Henoch-Schönlein purpura nephritis with mycophenolate mofetil. Pediatr Nephrol 2012;27:765-71.

35. Haeberle MT, Adams WB, Callen JP. Treatment of Severe Cutaneous Small-Vessel Vasculitis With Mycophenolate Mofetil. Arch dermatol 2012;148:887-8.

36. Kötter I, Henes JC, Wagner AD et al. Does glucocorticosteroid-resistant large-vessel vasculitis (giant cell arteritis and Takayasu arteritis) exist and how can remission be achieved? Critical review of the literature. Clin Exp Rheumatol 2012;30:114-29.

37. Shugaiv E, Tüzün E, Mutlu M et al. Mycophenolate mofetil as a novel immunosuppressant in the treatment of neuro-Behcet´s disease with parenchymal involvement: presentation of four cases. Clin Exp Rheumatol 2011;29:64-7.

38. Tzouvelekis A, Galanopoulos N, Bouros E et al. Effect and safety of Mycophenolate Mofetil or Sodium in Systemic Sclerosis-Associated Interstitial Lung Disease: A Meta-Analysis. Pulmonary medicine 2012

39. Aggarwal R, Oddis CV. Terapeutic advances in myositis. Curr Opin Rheumatol 2012;Epub

40. Owlia MB, Hemayati R, Zahir ST et al. Dermatomyositis Sine Myositis with Membranoproliferative Glomerulonephritis. Case Report Rheumatol 2012;Epub

41. Tsuruta D, Ishii N, hashimoto T. Diagnosis and treatment of pemphigus. Immunotherapy 2012;4:735-45.

42. Sodikoff JB, Keilin SA, Cai Q. Mycophenolate mofetil for maintenance of remission in steroid-dependent autoimmune pancreatitis. World J Gastroenterol 2012;18:2287-90.

43. Klisovic DD. Mycophenolate mofetil use in the treatment of noninfectious uveitis. Dev Ophthalmol 2012;51:57-62.

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Dermatology & STDs Paediatric rheumatology Rheumatology
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