MMF for Lupus Nephritis Patients with Poor Kidney Function

For lupus nephritis patients with a very low eGFR, mycophenolate mofetil (MMF) may lead to faster recovery of kidney function compared with cyclophosphamide, reports a study in the American Journal of Kidney Diseases.

The study was a post hoc analysis of data from patients enrolled in the Aspreva Lupus Management Study, a large randomized trial of MMF versus cyclophosphamide for lupus nephritis. Of 370 patients enrolled, 32 had severely decreased kidney function: eGFR less than 30 mL/min/1.73 m2. Of those, 20 received MMF, target dosage 3 g/d; and 12 received cyclophosphamide, given in monthly intravenous pulses of 0.5 to 1.0 g/m2. Response was defined as decreased proteinuria and stabilization or improvement in serum creatinine levels.

Over 24 weeks, the response rate was similar between groups: 20.0 percent with MMF and 16.7 percent with cyclophosphamide. However, MMF was associated with more rapid improvement in kidney function, with a between-group difference of 1.51 mL/min/1.73 m2 per week. Serious adverse events occurred in 45.0 percent of patients with MMF versus 63.6 percent with cyclophosphamide.

Randomized trials suggest that oral MMF is an effective alternative to intravenous cyclophosphamide for the treatment of lupus nephritis. It has been unclear whether MMF is adequate therapy for patients with very low kidney function.

The new analysis finds similar response rates—but faster improvement in renal function—with MMF for lupus nephritis patients with low eGFR, compared with cyclophosphamide. The authors hope that their hypothesis-generating study will lead to further studies of the efficacy and safety of MMF for this group of patients [Walsh M, et al. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis with poor kidney function: a subgroup analysis of the Aspreva Lupus Management Study. Am J Kidney Dis 2013; 61:710–715].