Mycophenolate Mofetil versus Azathioprine for Maintenance Treatment of Lupus Nephritis
Mycophenolate Mofetil versus Azathioprine for Maintenance Treatment of Lupus Nephritis
No Thumbnail Available
Date
2016
Authors
Hasan Abu-Aisha
Babikir G. Kaballo
Ahmed Elias Ahmed
Musa Mohammed Nur
Ismail Osman Khalid
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
To compare the efficacy of mycophenolate mofetil (MMF) with that of azathioprine
(AZA) drugs in the maintenance therapy of lupus nephritis (LN) patients, we studied 81
Sudanese patients with LN (32 in Class III, 34 in Class IV, and 15 in combined Class V + IV of
the ISN/RPS 2003 Classification). All patients received induction therapy consisting of monthly
intravenous pulse doses of cyclophosphamide (CYC) (500 mg/m2 of body-surface area) for six
months, plus three consecutive pulses of intravenous methylprednisolone 15 mg/kg/day of body
weight (maximum 500 mg). Subsequently, 41 (50.6%) patients were randomized into a group that
received oral MMF (22 mg/kg/day), and 40 (49.4%) patients randomized to a group that received
oral AZA (2 mg/kg/day). All patients initially received oral prednisone (1 mg/kg of body weight
daily) for four weeks. The baseline characteristics of the two groups were similar. Total remission
rate was 75.3% (80.5% in MMF and 70% in AZA), complete remission rate of 54.3% (56.1%
with MMF and 52.5% with AZA), and a partial remission rate of 21% (24.4% with MMF and
17.5% with AZA) over 29 months. During maintenance therapy, six patients died (four in the
AZA group and two in the MMF group), and end-stage renal disease (ESRD) developed in five
patients (three in the AZA group and two in the MMF group). During the 36-months of the study,
both groups had comparable event-free survival rate for the composite end point of death or
ESRD and rate of relapse-free survival. Furthermore, both groups had no significant differences
in terms of frequency of hospitalization, amenorrhea, infection, nausea, and vomiting. We conclude
that our study showed that short-term therapy
with intravenous CYC followed by maintenance
therapy with oral MMF or AZA had
similar efficacy and safety for the treatment of
patients with moderate to severe LN.
Description
Keywords
Citation
Kaballo, B.G., Ahmed, A.E., Nur, M.M., Khalid, I.O. and Abu-Aisha, H., 2016. Mycophenolate mofetil versus azathioprine for maintenance treatment of lupus nephritis. Saudi Journal of Kidney Diseases and Transplantation, 27(4), p.717.
Kaballo, B.G., Ahmed, A.E., Nur, M.M., Khalid, I.O. and Abu-Aisha, H., 2016. Mycophenolate mofetil versus azathioprine for maintenance treatment of lupus nephritis. Saudi Journal of Kidney Diseases and Transplantation, 27(4), p.717.
Kaballo, B.G., Ahmed, A.E., Nur, M.M., Khalid, I.O. and Abu-Aisha, H., 2016. Mycophenolate mofetil versus azathioprine for maintenance treatment of lupus nephritis. Saudi Journal of Kidney Diseases and Transplantation, 27(4), p.717.