Mycophenolate mofetil in the treatment of lupus nephritis: An appraisal of recent data

After nearly two decades of relative requiescence, a plethora of new drugs or biologic agents are currently being studied for their therapeutic potential in lupus nephritis. While corticosteroid remains an indispensable component in induction treatment for severe proliferative lupus nephritis, the advent of mycophenolate mofetil (MMF) offers an alternative to cyclophosphamide (CTX), thereby reducing the occurrence of treatment-related adverse effects, especially in patients requiring multiple courses of therapy for flares. Data on the high treatment efficacy and favourable tolerability of MMF were first reported in Chinese patients with diffuse proliferative lupus nephritis. The improved safety profile of MMF was subsequently confirmed in patients of Caucasian, Hispanic, or African origin, in whom comparable or even better treatment efficacy compared with CTX was observed. However, the response rates differed between these studies. This review aims to provide a succinct update on the reported experience that compared MMF with other immunosuppressive agents in the treatment of lupus nephritis. Considering potential ethnic differences in the disease course and/or treatment response, it remains to be examined whether the favourable long-term clinical outcomes observed in Chinese patients with corticosteroid and MMF as continuous treatment from induction to maintenance could be reproduced in patients of other ethnic origins. In addition, the relative merit and cost-effectiveness of MMF against alternative maintenance immunosuppressive agents in the prevention of disease flares deserve further investigation. © 2006 Asia Pacific League of Associations for Rheumatology.link_to_subscribed_fulltex