Clinical and Experimental Nephrology

, Volume 14, Issue 3, pp 214–221

Is mycophenolate mofetil superior to pulse intravenous cyclophosphamide for induction therapy of proliferative lupus nephritis in Egyptian patients?

  • Eid M. El-Shafey
  • Said H. Abdou
  • Mohamed M. Shareef
Original Article

DOI: 10.1007/s10157-010-0270-7

Cite this article as:
El-Shafey, E.M., Abdou, S.H. & Shareef, M.M. Clin Exp Nephrol (2010) 14: 214. doi:10.1007/s10157-010-0270-7

Abstract

Background

Recent studies have suggested that mycophenolate mofetil (MMF) may offer advantages over intravenous cyclophosphamide (IVC) for the treatment of lupus nephritis. The aim of this study was to evaluate the efficacy of MMF compared with IVC in the induction therapy of proliferative lupus nephritis.

Methods

We randomly assigned 47 patients with newly diagnosed active proliferative lupus nephritis class III or IV to open-label oral MMF 2 g/day for 6 months or intravenous cyclophosphamide 0.5–1 g/m2 monthly for 6 months in addition to corticosteroids.

Results

In the intention-to-treat analysis, 14 of the 24 patients (58.33%) receiving MMF and 12 of the 23 patients receiving cyclophosphamide (52.17%) had remission (P = 0.48); complete remission occurred in 6 of the 24 patients (25%) and 5 of the 23 patients (21.74%), respectively (P = 0.53). Improvements in packed cell volume, the erythrocyte sedimentation rate, anti-double-stranded DNA antibodies titer (anti-dsDNA), serum complement, proteinuria, urinary activity, renal function, serum soluble interleukin-2 receptor alpha concentration and the systemic lupus activity measure score were similar in both groups. Two patients assigned to MMF and another patient assigned to IVC developed end-stage renal failure with commencement of dialysis. Adverse events were similar. Major infections occurred in two patients in each group. There was no difference in gastrointestinal side effects, but more diarrhea occurred in those receiving MMF.

Conclusion

In this 24-week trial, MMF or IVC combined with corticosteroids demonstrated equal efficacy in inducing remission of proliferative lupus nephritis.

Keywords

Intravenous cyclophosphamide (IVC)Mycophenolate mofetilProliferative lupus nephritis

Copyright information

© Japanese Society of Nephrology 2010

Authors and Affiliations

  • Eid M. El-Shafey
    • 1
    • 4
  • Said H. Abdou
    • 2
  • Mohamed M. Shareef
    • 3
  1. 1.Division of Nephrology, Department of Internal MedicineTanta University Hospitals, Tanta UniversityTantaEgypt
  2. 2.Department of Clinical PathologyTanta UniversityTantaEgypt
  3. 3.Department of Pathology, Faculty of MedicineTanta UniversityTantaEgypt
  4. 4.JahraKuwait