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Azathioprine versus mycophenolate mofetil for long-term immunosuppression in lupus nephritis: results from the

Frédéric A Houssiau1, David D'Cruz, Shirish Sangle

  • 1Rheumatology Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Saint-Luc University Hospital, Brussels 1200, Belgium. frederic.houssiau@uclouvain.be

Annals of the Rheumatic Diseases
|September 14, 2010
PubMed
Abstract

Insights

Mycophenolate mofetil (MMF) showed a trend toward fewer renal flares than azathioprine (AZA) in lupus nephritis (LN) maintenance therapy, but the difference was not statistically significant. Both treatments demonstrated similar efficacy and safety profiles for lupus nephritis patients.

Area of Science:

  • Nephrology
  • Rheumatology
  • Immunology

Background:

  • Long-term immunosuppressive therapy often fails to prevent lupus nephritis (LN) relapses.
  • Investigator-initiated randomized trial to compare mycophenolate mofetil (MMF) and azathioprine (AZA) for maintenance treatment in LN.

Purpose of the Study:

  • To determine if mycophenolate mofetil (MMF) is superior to azathioprine (AZA) in preventing renal flares in patients with lupus nephritis (LN).

Main Methods:

  • 105 patients with proliferative lupus nephritis (LN) received induction therapy (methylprednisolone, cyclophosphamide).
  • Patients were randomized to receive either azathioprine (AZA) or mycophenolate mofetil (MMF) as maintenance therapy starting at week 12.
  • Primary endpoint was time to renal flare, with a mean follow-up of 48 months.

Main Results:

  • Renal flares occurred in 25% of AZA-treated and 19% of MMF-treated patients; this difference was not statistically significant.
  • Time to renal flare, severe systemic flare, benign flare, and renal remission did not differ significantly between groups.
  • Adverse events were similar, except for more frequent hematological cytopenias in the AZA group (p=0.03).

Conclusions:

  • Mycophenolate mofetil (MMF) demonstrated a trend towards fewer renal flares compared to azathioprine (AZA) in lupus nephritis (LN) maintenance, though not statistically significant.
  • Both MMF and AZA showed comparable efficacy and safety profiles for long-term lupus nephritis management.

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