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Experience with mycophenolate mofetil as maintenance therapy in five pediatric patients with severe systemic lupus

K Dittrich1, S Ross, K Benz

  • 1Department of Pediatric Nephrology, University of Erlangen-Nürnberg, Germany.

Klinische Padiatrie
|December 17, 2009
PubMed

Insights

Mycophenolate mofetil (MMF) effectively reduced disease activity and prednisone dosage in pediatric patients with severe systemic lupus erythematosus (SLE). MMF proved safe and beneficial for maintenance therapy, decreasing flares in children and adolescents.

Area of Science:

  • Pediatric Rheumatology
  • Immunology
  • Clinical Pharmacology

Background:

  • Systemic lupus erythematosus (SLE) in children often requires aggressive maintenance therapy.
  • Current standard maintenance therapy involves azathioprine and prednisone.
  • Mycophenolate mofetil (MMF) is used in adults, but its efficacy and safety in pediatric SLE maintenance are less established.

Purpose of the Study:

  • To evaluate the efficacy of MMF as maintenance therapy in pediatric SLE.
  • To assess MMF's ability to decrease disease activity and glucocorticoid requirements.
  • To investigate MMF's safety profile in children and adolescents with SLE.

Main Methods:

  • A cohort of five pediatric SLE patients received daily MMF (1.2+/-0.20 g/m^2).
  • Patients included those with severe renal or cerebral involvement, or frequent flares on azathioprine.
  • Disease activity (SLEDAI), flares, and prednisone dosage were monitored monthly over a mean follow-up of 39 months.

Main Results:

  • The number of flares decreased significantly from 1.28 to 0.25 episodes per patient-year.
  • Prednisone dosage was reduced from 10.80+/-5.25 mg/d to 3.25+/-1.18 mg/d (p<0.01).
  • Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores dropped from 15.20+/-2.8 to 3.60+/-0.9 (p<0.001).

Conclusions:

  • MMF demonstrated effectiveness and safety as maintenance therapy for severe pediatric SLE over 3.5 years.
  • MMF successfully prevented flares, even in patients with a history of azathioprine treatment failure.
  • Further confirmation through randomized multicenter clinical trials is warranted.

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