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Mycophenolate mofetil and systemic lupus erythematosus

Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Padova, Italy, adoria{at}unipd.it

L Iaccarino

Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Padova, Italy

S Arienti

Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Padova, Italy

M E Rampudda

Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Padova, Italy

M G Canova

Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Padova, Italy

R Rondinone

Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Padova, Italy

S Todesco

Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Padova, Italy

Mycophenolate mofetil (MMF) is an immunosuppressive agent which provides protection against acute transplant rejection, in patients who undergo kidney, heart and liver transplantation. Recently MMF has been used in various autoimmune conditions, including systemic lupus erythematosus (SLE). In SLE, MMF has been more extensively used in the treatment of proliferative lupus glomerulonephritis (GLN) and following the success in this field, it has also been used to control extra-renal manifestations. However, in the majority of cases MMF was administered to patients with refractory SLE manifestations and, therefore, no definite conclusion could be drawn from these experiences.

In this paper, after a brief description of the mechanisms of action, the pharmacokinetics and metabolism of MMF which are relevant in SLE, and after a short discussion on the utility of performing therapeutic dose monitoring of mycphenolic acid, the experiences with the use of this drug in the different SLE manifestations were summarized and some personal data in patients with GLN were reported. Finally, the hypothetical use of MMF as a preventive strategy against the occurrence of severe manifestations in patients with mild SLE has been put forward and discussed.

Key Words: systemic lupus erythematosus • mycophenolate mophetil • lupus nephritis • immunosuppressants • therapy • prognosis • secondary prevention

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