Remission of severe relapsing or persistent lupus nephritis using mycophenolate mofetil

The therapy of severe lupus nephritis (LN) consists of high-dose steroids and immunosuppressive agents, usually cyclophosphamide. Although effective in up to 90% of cases, this approach leads to undesirable complications in many cases. In recent years, mycophenolate mofetil (MMF), an immunosuppressive drug used in transplantation regimes, seems to be effective in selected cases of lupus nephritis.

In this report we present the results using MMF in seven cases of LN. MMF stabilized renal function, controlled extrarenal disease activity and led to less steroid dosing.

Three patients achieved complete remission, two partial remissions and two failed, although these two patients were the ones with the highest chronicity indices in the renal biopsies. However, they were able to maintain stable renal function for more than one year with tolerable side effects. In two more patients the latter were mild and did not require either hospitalization or intense therapy.

MMF can be an option for selected cases with severe relapsing or persistent LN and can lead to induction of remission. This observation needs to be expanded. Larger randomized controlled studies are needed to evaluate its indication in earlier cases as induction of de novo disease and/or effective remission maintenance.