Mycophenolate Mofetil (CellCept) Dosing for Lupus Nephritis in Children
The recommended dosing of mycophenolate mofetil (CellCept) for lupus nephritis in children is 600 mg/m² administered twice daily (up to a maximum of 1 g twice daily), with a target starting dose of 1200 mg/m²/day divided in two doses. 1
Dosing Guidelines Based on Body Surface Area
- For children with BSA < 1.25 m²: 600 mg/m² twice daily
- For children with BSA 1.25-1.5 m²: 750 mg twice daily (1.5 g daily)
- For children with BSA > 1.5 m²: 1 g twice daily (2 g daily) 1
Therapeutic Monitoring and Dose Adjustments
- Target area under the curve (AUC) > 50 μg-h/ml
- Treatment should be continued for at least 36 months (including initial and maintenance phases) 2
- During maintenance phase, dose can be reduced to approximately 750-1000 mg twice daily 2
- Monitor complete blood count regularly to assess for leukopenia
- Adjust dose in case of significant adverse effects, particularly gastrointestinal symptoms
Treatment Duration and Monitoring
- Initial treatment phase: Higher doses (as above) for 6 months
- Maintenance phase: Continue treatment for at least 36 months total 2
- Regular monitoring should include:
- Renal function (serum creatinine, eGFR)
- Proteinuria
- Complete blood count
- Serum albumin
- Complement levels (C3, C4)
- Anti-dsDNA antibody levels 3
Special Considerations
- For patients experiencing significant abdominal pain, consider switching to mycophenolic acid sodium at equivalent doses (360 mg sodium mycophenolate corresponds to 500 mg mycophenolate mofetil) 3
- In Asian populations, lower doses (0.5-1 g/day) may be effective with fewer side effects 4
- Treatment should be combined with glucocorticoids, typically starting with oral prednisone 0.5 mg/kg/day for 4 weeks, reducing to ≤10 mg/day by 4-6 months 3
Potential Adverse Effects to Monitor
- Infections (most common serious adverse effect)
- Leukopenia
- Gastrointestinal symptoms (nausea, diarrhea, abdominal pain)
- Headache
- Fatigue 5
Important Caveats
- Mycophenolate mofetil is contraindicated during pregnancy due to teratogenic effects
- For female patients of childbearing potential, ensure effective contraception is used
- If pregnancy is contemplated, switch to azathioprine at least 3 months prior to conception 3
- Mycophenolate mofetil should be continued for at least 2 months after achieving remission, as most children will relapse when it is stopped 3
- Consider switching to azathioprine for maintenance therapy if mycophenolate mofetil is not tolerated or if pregnancy is planned 3
By following these dosing guidelines and monitoring protocols, mycophenolate mofetil can be effectively and safely used to treat lupus nephritis in children, improving outcomes and reducing the risk of progression to end-stage renal disease.