From the Guidelines
Mycophenolate mofetil (MMF) is a crucial immunosuppressive therapy for lupus nephritis, and it is recommended to be used for induction and maintenance treatment, with a dosage of 2-3 grams daily, due to its efficacy in reducing kidney flares and improving patient outcomes, as shown in the 2020 EULAR/ERA-EDTA recommendations 1.
Key Points
- MMF is a first-line treatment for lupus nephritis, particularly for Class III, IV, and V disease, and is often preferred over cyclophosphamide due to its more favorable side effect profile and lower risk of infertility.
- The recommended dosage of MMF is typically 2-3 grams daily, divided into two doses, with a target dose of 1-1.5 grams twice daily, as suggested by the 2012 American College of Rheumatology guidelines 2.
- MMF works by inhibiting inosine monophosphate dehydrogenase, thereby blocking T and B lymphocyte proliferation and reducing autoantibody production.
- Common side effects of MMF include gastrointestinal disturbances (diarrhea, nausea), increased risk of infections, and myelosuppression, and regular monitoring of complete blood counts and renal function is essential.
- MMF is contraindicated during pregnancy, so effective contraception is necessary for women of childbearing potential, and for patients who cannot tolerate MMF, mycophenolic acid (Myfortic) may be better tolerated due to its enteric coating.
Treatment Recommendations
- MMF should be used as a first-line treatment for lupus nephritis, with a dosage of 2-3 grams daily, and should be combined with corticosteroids during the induction phase (first 3-6 months), followed by a maintenance phase at a lower dose (1-2 grams daily) for at least 3 years, as recommended by the 2020 EULAR/ERA-EDTA guidelines 1.
- The treatment should be tailored to the individual patient's needs, with consideration of factors such as disease severity, patient age, and potential side effects.
- Regular monitoring of patient outcomes, including kidney function and disease activity, is essential to adjust the treatment plan as needed and minimize the risk of kidney flares and other complications.
From the Research
Role of Mycophenolate Mofetil in Lupus Nephritis
- Mycophenolate Mofetil (MMF) has been shown to be effective in the treatment of lupus nephritis, with studies suggesting it may be as or more effective than cyclophosphamide in inducing remission 3, 4.
- MMF has been found to reduce the risk of failure to induce remission and may reduce the risk of death or end-stage renal disease compared to cyclophosphamide 3.
- The efficacy of MMF in lupus nephritis has been demonstrated in various ethnic populations, including Taiwanese patients, who may respond to lower doses of MMF than Caucasian patients 5.
- Long-term use of MMF has been shown to be effective in maintaining renal remission and preventing flares in patients with lupus nephritis, with a low progression rate to end-stage renal disease 6.
- MMF has a more favorable safety profile compared to cyclophosphamide, with fewer severe infections and hospitalizations, but may cause more diarrhea 4.
- The use of MMF in lupus nephritis has been supported by randomized controlled trials, which have defined its potential toxicity and efficacy in both induction and maintenance therapy 7.
Key Findings
- MMF is effective in inducing remission in lupus nephritis, with response rates ranging from 60% to 80% 3, 5, 4.
- MMF may be considered as a first-line induction therapy for the treatment of lupus nephritis in patients without severe renal dysfunction 3.
- Long-term use of MMF is effective in maintaining renal remission and preventing flares in patients with lupus nephritis 6.
- MMF has a relatively benign adverse effect profile, with the most common adverse effects being leukopenia, nausea, and diarrhea 6, 4.