Vol.23 No.1

Original Article

Mycophenolate mofetil versus intravenous cyclophosphamide for induction treatment of proliferative lupus nephritis in a Japanese population: a retrospective study

Authors

Akira Onishi1,2 , Daisuke Sugiyama1 , Go Tsuji3 , Takashi Nakazawa4 , Yoshinori Kogata2 , Kosaku Tsuda2 , Ikuko Naka2 , Keisuke Nishimura2 , Kenta Misaki2 , Chiyo Kurimoto2 , Hiroki Hayashi5 , Goichi Kageyama2, Jun Saegusa1,2, Takeshi Sugimoto2, Seiji Kawano2, Shunichi Kumagai1,3, Akio Morinobu2

  • Department of Evidence Based Laboratory Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
  • Department of Clinical Pathology and Immunology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
  • Department of Rheumatic Diseases, Shinko Hospital, 1-4-47 Wakihama-cho, Chuo-ku, Kobe, 651-0072, Japan
  • Department of Rheumatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
  • Department of Nephrology, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
Received:

22 December 2011

Accepted:

8 March 2012

Published online:

25 March 2012

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Abstract

Objectives Recent studies have shown that mycophenolate mofetil (MMF) is similar to intravenous cyclophosphamide (IVC) for the treatment of lupus nephritis (LN), but that treatment response may vary according to location and race/ethnicity. Moreover, no studies have been conducted to compare the efficacy of MMF with that of IVC for a Japanese population. We therefore conducted a retrospective study to clarify the efficacy and safety of MMF compared with that of IVC for induction therapy for active LN, classes III and IV, in a Japanese population of 21 patients, 11 of whom received MMF and 10 IVC.
Methods The primary endpoint was expressed as the percentage of responders, who in turn were defined as the patients who met complete or partial response criteria according to the European consensus statement. The secondary endpoints comprised the renal activity component and serological activity.
Results The primary endpoint was achieved in nine (81.8 %) patients receiving MMF and in four (40.0 %) receiving IVC, with no significant difference between the two groups (p = 0.081), while there was also no significant difference between them in terms of secondary endpoints. However, the MMF group suffered significantly fewer hematologic toxic effects than the IVC group.
Conclusions MMF may be used as an alternative to IVC for inducing renal remission of LN in Japanese patients.

Key words

Cyclophosphamide - Japanese population - Lupus nephritis - Mycophenolate mofetil - Systemic lupus erythematosus