Outcomes of Mycophenolate Mofetil vs. Intravenous
Cyclophosphamide in Induction Therapy of Childhood-
Onset Lupus Nephritis
Suwannee Wisanuyotin, MD¹, Anirut Pattaragarn, MD², Ankanee Chanakul, MD³, Adisorn Lumpaopong, MD⁴,
Wattana Chartapisak, MD⁵
Affiliation : ¹ Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand ² Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand ³ Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand ⁴ Department of Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand ⁵ Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Background: Intravenous cyclophosphamide (IVCY) concomitant with corticosteroids demonstrated better outcomes in therapy
of proliferative lupus nephritis albeit adverse effects may occur. Mycophenolate mofetil (MMF) is a newer oral medication for
treating lupus nephritis.
Objective: To compare renal outcomes between IVCY and MMF in conjunction with corticosteroid for induction therapy of proliferative lupus nephritis.
Materials and Methods: The authors reviewed the medical records from four university hospitals of children who received prednisolone with either MMF or IVCY for induction therapy of proliferative lupus nephritis between 2005 and 2014 in the present retrospective cohort study.
Results: Twenty-eight and 85 patients were included in the MMF and IVCY group, respectively. The respective mean age at MMF and IVCY initiation was 12.36±2.87 and 11.84±3.04 years. Renal remission was not significantly different between the groups (p=0.690). Non-nephrotic range proteinuria (adjusted OR 2.93, 95% CI 1.23 to 6.94, p=0.015), and high initial GFR (adjusted OR 2.93, 95% CI 1.14 to 7.56, p=0.026) were significantly associated with achieving renal remission. Both infectious (82.1%) and non-infectious complications (96.9%) were more common in the IVCY group. Neither death nor end-stage renal disease (ESRD) occurred during the induction therapy.
Conclusion: There was no significant difference in renal remission whether children received MMF or IVCY for induction therapy of lupus nephritis; however, adverse events occurred less frequently in the MMF group.
Received 20 Mar 2020 | Revised 18 May 2020 | Accepted 19 May 2020
doi.org/10.35755/jmedassocthai.2020.08.11180
Keywords : Children, Lupus nephritis, Systemic lupus erythematosus, Mycophenolate, Cyclophosphamide, Induction
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