Nonrenal disease activity following mycophenolate mofetil or intravenous cyclophosphamide as induction treatment for lupus nephritis: findings in a multicenter, prospective, randomized, open-label, parallel-group clinical trial
Ginzler, Ellen M; Wofsy, David; Isenberg, Davidet al.
2010 • In Arthritis and Rheumatism, 62 (1), p. 211-221
[en] OBJECTIVE: To assess the effect of mycophenolate mofetil compared with
intravenous pulses of cyclophosphamide on the nonrenal manifestations of lupus
nephritis. METHODS: Patients with active lupus nephritis (renal biopsy class III,
IV, or V) were recruited for the study (n = 370) and treated with mycophenolate
mofetil (target dosage 3 gm/day) or intravenous cyclophosphamide (0.5-1.0
gm/m(2)/month), plus tapered prednisone, for 24 weeks. Nonrenal outcomes were
determined using measures of whole body disease activity, including the British
Isles Lupus Assessment Group (BILAG) disease activity index, the Safety of
Estrogens in Lupus Erythematosus: National Assessment (SELENA) version of the
Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and immunologic
variables. RESULTS: Both treatments were effective on whole body disease activity
in the systems examined, as indicated by changes in the classic BILAG index. With
either treatment, remission was induced, notably in the mucocutaneous,
musculoskeletal, cardiovascular/respiratory, and vasculitis systems, and flares
were rare, as measured by the SELENA-SLEDAI. Levels of complement C3, C4, and
CH50 and titers of anti-double-stranded DNA antibodies were normalized after
treatment with either mycophenolate mofetil or intravenous cyclophosphamide.
CONCLUSION: In addition to the efficacy of both treatments on the renal system,
this analysis showed that remission could also be induced in other systems. There
was no clear difference in efficacy between mycophenolate mofetil and intravenous
cyclophosphamide in ameliorating either the renal or nonrenal manifestations.
Mycophenolate mofetil is, therefore, a suitable alternative to cyclophosphamide
for the treatment of renal and nonrenal disease manifestations in patients with
biopsy-proven lupus nephritis.
Disciplines :
Rheumatology
Author, co-author :
Ginzler, Ellen M
Wofsy, David
Isenberg, David
Gordon, Caroline
Lisk, Laura
Malaise, Michel ; Université de Liège - ULiège > Département des sciences cliniques > Rhumatologie
Dooley, Mary-Anne
Language :
English
Title :
Nonrenal disease activity following mycophenolate mofetil or intravenous cyclophosphamide as induction treatment for lupus nephritis: findings in a multicenter, prospective, randomized, open-label, parallel-group clinical trial
Publication date :
2010
Journal title :
Arthritis and Rheumatism
ISSN :
0004-3591
eISSN :
1529-0131
Publisher :
Wiley Liss, Inc., New York, United States - New York
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