Clinical investigation of mycophenolate mofetil treatment for refractory lupus nephritis

Objective To investigate the effects of mycophenolate mofetil (MMF) treatment for refractory lupus nephritis (LN). Methods Thirty eight patients with LN, who had failed intermittent cyclophosphamide (CTX) intravenous treatment or had relapsed or to withdraw because of adverse reactions, had received the MMF treatment for 12 months. The clinical efficacy and immunology indexes were assessed. The dosage of MMF was decreased after treated for 6 months. Results The cases with edema, arthralgia,skin rashes,anemia, low white blood cell and blood urine after one month of MMF treatment were significantly less than that before treatment. Edema, arthralgia, skin rashes and low white blood cell disappeared after 3 months of treatment. During the first 6 month of MMF treatment, urine protein, erythrocyte sedimentation rate, blood urea nitrogen and blood creatinine were significantly reduced, anti-dsDNA antibody titer decreased gradually, serum albumin increased, but the changes became slower after 6 months. The renal function of 14 cases (88%) in 16 patients with renal failure recovered after 6 months of MMF treatment. During MMF treatment serum complement 3 increased and anti-nucleus antidodies decreased, serum complement 4 increased significantly after treatment for 12 months. The difference, compared with that of before treatment, was significant. The incidence of adverse effects of MMF treatment was less than before treatment (24% vs 74%). Conclusion MMF treatment for refractory LN is effective with few side-effects. The efficacy may be dose dependent.