Mycophenolate mofetil for induction therapy of lupus nephritis: a systematic review and meta-analysis.

Abstract

BACKGROUND AND OBJECTIVES:

Although the accepted standard of care for induction of lupus nephritis has been cyclophosphamide, recent trials suggest that mycophenolate mofetil may be as or more effective and less toxic. A systematic review and meta-analysis were performed to determine the risk for failure to induce remission of lupus nephritis in patients who were treated with mycophenolate mofetil compared with cyclophosphamide.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

Studies were identified by a search of electronic databases, bibliographies, and conference proceedings and by contacting experts. Randomized trials that compared mycophenolate mofetil with cyclophosphamide for induction therapy in adults with biopsy-proven lupus nephritis were eligible. The primary outcome was failure to induce a remission of nephritis as defined by the original studies (based on proteinuria, renal function, and urine sediment).

RESULTS:

Four studies that included 268 patients and had homogeneous results across studies were identified. In a fixed-effects model, the pooled relative risk for failure to induce remission for mycophenolate mofetil compared with cyclophosphamide was 0.70. The relative risk for the composite outcome of death or end-stage renal disease for mycophenolate mofetil compared with cyclophosphamide was 0.44. Leukopenia and amenorrhea occurred more frequently in cyclophosphamide-treated patients.

CONCLUSIONS:

Treatment of lupus nephritis with mycophenolate mofetil compared with cyclophosphamide reduces the risk for failure to induce remission during induction therapy and may reduce the risk for death or end-stage renal disease. Mycophenolate mofetil may be considered as a first-line induction therapy for the treatment of lupus nephritis in patients without severe renal dysfunction.

• Authors: Michael Walsh, Matthew James, David Jayne, Marcello Tonelli, Braden J Manns, Brenda R Hemmelgarn
• Journal: Clinical journal of the American Society of Nephrology : CJASN (Clin J Am Soc Nephrol) Vol. 2 Issue 5 Pg. 968-75 (Sep 2007) ISSN: 1555-905X [Electronic] United States
• PMID: 17702723 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)

Chemical References

• Immunosuppressive Agents
• Mycophenolic Acid

Topics

• Humans
• Immunosuppressive Agents (therapeutic use)
• Lupus Nephritis (drug therapy)
• Mycophenolic Acid (analogs & derivatives, therapeutic use)