Document Detail


Maintenance therapy with mycophenolate mofetil for children with severe lupus nephritis after low-dose intravenous cyclophosphamide regimen.
MedLine Citation:
PMID:  18414900     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Although recent studies on adults with lupus nephritis indicate that mycophenolate mofetil (MMF) may be effective in maintaining remission for patients who previously received short-term intravenous cyclophosphamide (IVCY) induction therapy, the experience with the new immunosuppressive agent in children with severe lupus nephritis has not been as satisfactory thus far. To assess the efficacy and safety of maintenance therapy with MMF, we prospectively analyzed four patients with biopsy-proven severe lupus nephritis (three girls, one boy; mean age 12 years; two with class IIIA, two with class IVG(A); mean duration of lupus nephritis 7 months) receiving MMF for at least 6 months after induction treatment. These patients had been treated previously with 6 months of low-dose IVCY combined with oral mizoribine and steroids for induction, followed by therapy with MMF adjusted to maintain predose mycophenolic acid (C0-MPA) levels at 2-5 mcg/ml. Mean follow-up after staring MMF was 27.5 months (range 6-41). The mean MMF dose required was 405 +/- 49 mg/m(2) per 12 h, which maintained mean C0-MPA levels of 3.3 +/- 0.41 mcg/ml. No patient experienced renal flares during maintenance therapy with MMF, which permitted a significant reduction in mean prednisolone dose from 11.9 +/- 1.3 to 3.9 +/- 2.6 mg/day (P = 0.003). No significant gastrointestinal or hematologic side effects of MMF were noted. This preliminary study demonstrates that maintenance therapy with MMF after a low-dose IVCY regimen appears to be a promising intervention without adverse effects in children with severe lupus nephritis. These data should be confirmed by a prospective randomized multicenter clinical trial.
Authors:
Shuichiro Fujinaga; Yoshiyuki Ohtomo; Satoshi Hara; Daisuke Umino; Tomonosuke Someya; Toshiaki Shimizu; Kazunari Kaneko
Publication Detail:
Type:  Journal Article     Date:  2008-04-15
Journal Detail:
Title:  Pediatric nephrology (Berlin, Germany)     Volume:  23     ISSN:  0931-041X     ISO Abbreviation:  Pediatr. Nephrol.     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-09-03     Completed Date:  2008-11-18     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  8708728     Medline TA:  Pediatr Nephrol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1877-82     Citation Subset:  IM    
Affiliation:
Division of Nephrology, Saitama Children's Medical Center, Saitama-city Saitama, 339 8551, Japan. f_shuich@d2.dion.ne.jp
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Azathioprine / administration & dosage
Child
Cyclophosphamide / administration & dosage*
Drug Therapy, Combination
Female
Humans
Immunosuppressive Agents / administration & dosage*
Lupus Nephritis / drug therapy*
Male
Mycophenolic Acid / administration & dosage,  analogs & derivatives*
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents; 24280-93-1/Mycophenolic Acid; 446-86-6/Azathioprine; 50-18-0/Cyclophosphamide; 9242ECW6R0/mycophenolate mofetil

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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