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Abstract
Objective
Although intravenous cyclophosphamide (IVC) is generally accepted as the standard therapy for induction treatment of active proliferative lupus nephritis (LN), several clinical trials have suggested that mycophenolate mofetil (MMF) is at least as effective as IVC. Because few Asian studies have compared the two treatment modalities, we compared the efficacies of MMF and IVC as LN remission induction treatments in Korean patients.
Methods
We enrolled 39 patients with class III and IV LN who received MMF or IVC as LN induction therapy. The renal outcomes (i.e., complete response [CR], partial response [PR], and no response [NR]) at 6 and 12 months were defined using the ACR 2006 response criteria.
Results
Of 39 patients, 23 (59.0%) were treated with IVC, and 16 (41.0%) were treated with MMF. Demographics, clinical characteristics, laboratory data, and adverse events did not significantly differ between the two groups. However, C3 levels were lower and activity scores in renal biopsy were higher in IVC-treated patients. CRs were achieved by 11 (47.8%) of the patients receiving IVC and 7 (43.8%) of the patients receiving MMF after 6 months of treatment (p=0.961) and by 11 (47.8%) of those who received IVC and 9 (56.2%) of those who received MMF at 12 months of treatment (p=0.713). Neither the PR rate nor the NR rate differed significantly at 6 or 12 months between the two groups.
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Table 1.
Demographic and laboratory characteristics of the two different treatment groups at the time of renal biopsy
Values are presented as mean±standard deviation or number (%). IVC: intravenous cyclophosphamide, MMF: mycophenolate mofetil, LN: lupus nephritis, SLEDAI: systemic lupus erythematosus disease activity index, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein, HDL: high-density lipoprotein, LDL: low-density lipoprotein, eGFR: estimated glomerular filtration rate, aCL: anti-cardiolipin, β2 GPI: beta2-glycoprotein I.
Table 2.
Renal biopsy findings in the two different treatment groups
Table 3.
Medications used by LN patients in the two different treatment groups
Table 4.
Renal responses in the two different treatment groups at 6 and 12 months
Table 5.
Adverse events in the two different treatment groups over 12 months
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