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Mycophenolate mofetil as the primary treatment of membranous lupus nephritis with and without concurrent proliferative disease: a retrospective study of 29 cases

Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA

M. Petri

Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA

M. Haas

Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA

L.S. Magder

Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, MD 21201, USA

D.M. Fine

Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA, dfine1{at}jhmi.edu

Studies of immunosuppressive therapy, particularly mycophenolate mofetil (MMF), in membranous lupus nephritis (MLN) are limited. We report on our experience with primary (first-line) MMF therapy to induce and sustain renal remission in MLN with and without a concurrent proliferative lesion. Systemic lupus erythematosus (SLE) patients were studied, retrospectively, if treated with MMF for newly diagnosed MLN. Complete remission was defined as proteinuria less than 0.5 g/24h, inactive urine sediment and normal estimated glomerular filtration rate. Response in pure MLN (Group I, n = 10) was compared with mixed MLN and proliferative lupus nephritis (Group II, n = 19). By 12 months, 4 (40%) patients in Group I and 7 (36.8%) in Group II achieved complete remission (P = 0.87). One (10%) patient in Group I and 2 (10.5%) in Group II had worsening renal disease (P = 0.97). Mean time to remission was more than seven months in both groups. The remaining patients had stable disease without improvement or worsening. Only 2 of 11 achieving initial remission had a relapse with an average of 28 months of follow-up after remission. Self-limited gastrointestinal symptoms occurred in 12 patients, none requiring withdrawal of the drug. Mycophenolate mofetil as a primary therapy in MLN was successful in inducing complete remission in about 40% of MLN, particularly in patients with mild proteinuria. However, 12 months of therapy was necessary for best outcomes. Response rate was not different in the presence or absence of a proliferative lesion. Lupus (2008) 17, 40—45.

Key Words: immunosuppressant • membranous lupus nephritis • mycophenolate mofetil

Lupus, Vol. 17, No. 1, 40-45 (2008)
DOI: 10.1177/0961203307085114


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