[Rescue therapy in lupus nephritis patients with mycophenolate mofetil]

Area of Science:

• Nephrology
• Immunology
• Rheumatology

Background:

• Proliferative lupus nephritis (LN) treatment traditionally involves cyclophosphamide and steroids, associated with significant toxicity.
• Mycophenolate mofetil (MMF), an immunosuppressant used in transplantation, is emerging as a potential therapeutic option for select LN cases.

Observation:

• This study describes six patients with Lupus Nephritis (LN) classes IV and V treated with MMF as a rescue therapy.
• MMF was utilized due to various reasons, aiming to stabilize renal function and control systemic lupus erythematosus (SLE) activity.

Findings:

• Three patients achieved complete remission, while two experienced partial remission.
• One patient discontinued MMF due to severe adverse events (thrombocytopenia, leukopenia, sepsis-induced pneumonopathy).
• Another patient developed Zoster Herpes, managed with acyclovir and temporary MMF cessation.

Implications:

• MMF demonstrates efficacy in achieving remission and maintaining inactive SLE, positioning it as a valuable rescue or maintenance therapy post-cyclophosphamide induction.
• MMF may be considered an elective treatment for LN patients prioritizing fertility.
• Long-term follow-up is crucial to evaluate MMF's impact on renal survival compared to cyclophosphamide.