Outcome of long-term treatment with mycophenolate mofetil in patients with severe lupus nephritis

Abstract

BACKGROUND: Corticosteroids with mycophenolate mofetil (MMF) has proven efficacy when used as induction or maintenance immunosuppression for proliferative lupus nephritis, but data on long-term mycophenolate mofetil treatment is lacking. METHODS: This was a single-centre retrospective study of patients with Class III/IV±V lupus nephritis who have received prednisolone and MMF continuously as treatment in the early phase and the long-term maintenance phase. RESULTS: 65 patientswere included. 31 patients were treated with only prednisolone and MMF throughout (Group I). 23 patients had their MMF substituted with azathioprine (AZA)(Group II) and 11 patients with calcineurin inhibitors (CNI)(Group III) at some point during the maintenance phase. The follow-up was 91.9±47.7 months. The 10-year patient and renal survival rates were 91% and 86% respectively, with no difference between the three groups. Relapse-free survival was higher in Group I than Group II and Group III (76% vs 56% vs 43% respectively at 5-year; 69% vs 32% vs 0% respectively at 10-year; I vs II, p=0.049; I vs III, p=0.019; II vs III, p=0.490). Patients who received MMF for more than 24 months showed better relapse-free survival than those treated for shorter durations (88% vs 48% respectively at 5-year; 81% vs 28% respectively at 10-year; p<0.001). Serum creatinine was lower in Group I at 10 years. Apart from more anemia with MMF treatment, the side-effects profile was similar in patients during MMF, AZA, or CNI treatment. CONCLUSIONS: Continuous treatment with corticosteroids and MMF as both induction and long-term maintenance immunosuppression is associated with favorable long-term outcome and possibly a lower risk of disease flare compared with other maintenance immunosuppressive medications.