Review of MMF in lupus nephritis

is at least equivalent to IV cyclophosphamide in terms of safety and efficacy in the treatment of lupus nephritis, a review concludes. Lupus nephritis is the most common severe manifestation of systemic lupus erythromatosus and cyclophosphamide and corticosteroids are the commonly accepted standard of care for remission induction, the authors wrote in their review paper published in Current Opinion in Rheumatology. However, they note that as cyclophosphamide is associated with toxicity and a significant proportion of patients fail to achieve remission, safer more effective therapies are needed and MMF may prove to be such an alternative. MMF is a morpholinoethyl ester prodrug which undergoes absorption and rapid hepatic hydrolisation to produce MPA, which is believed to be relatively lymphocyte selective compared with azathioprine, with a more targeted mechanism of action than cyclophosphamide. The reviewers found that current evidence showed that MMF was at least as effective as IV cyclophosphamide in terms of safety and efficacy for lupus nephritis, with a possible added benefit in black populations. They said that for remission maintenance there was no current evidence to suggest that MMF is superior to azathioprine, however, results from larger randomised trials (e.g ALMS and MAINTAIN) are awaited, and longer follow up to further assess end stage renal failure and mortality rates is required. Current trials have excluded patients with severe renal impairment because the toxicity of MMF may be increased in these patients. While only a minority of patients with lupus present with advanced renal failure the safety and efficacy of MMF in this subgroup is still warranted, the authors stated. Further research is also required to optimise MMF and corticosteroid dosing regimens and duration, they concluded. Current Opinion in Rheumatology 2009; 21.256:261....