Mycophenolate mofetil versus intravenous pulse cyclophosphamide for class IV plus V lupus nephritis

Objective:Lupus nephritis with diffuse proliferation ( type Ⅳ lesion) and membranous lesion (type Ⅴ lesion) is associated with poor prognosis and refractory response to treatment. In this study, we retrospectively compared the clinical efficacy and side-effects in patients with class Ⅳ+Ⅴ lupus nephritis who recieved mycophenolate mofetil(MMF) regime or intravenous pulse cyclophosphamide(CTX) regime. Methodology:Forty-three lupus patients classified as type (Ⅳ+Ⅴ) lupus nephritis after renal biopsy, according to the criteria of ISN/RPS 2003, were treated with intravenous methylprednisolone and MMF (MMF group,n=20) or with intravenous methylprednisolone and pulse cyclophophamide (CTX group,n=23). MMF was given at a dosage of 1.5～2.0 g/d, and CTX was administered as intravenous pulse therapy (0.75～1 g/m~2BSA) monthly for at least 6 months. Patients received these two regimes were comparable in general conditions and clinicopathological parameters for the activity and severity of renal damage. Patients in MMF group had a higher average level of serum creatinine. Results:In patients receiving intravenous CTX therapy, the complete remission rate and the partial remission rate at the 6~ thmonth were only 4.4% and 34.8%. While in patients of MMF group, the complete remission rate and the partial remission rate at the 6~ thmonth were 20% and 60%, both with a significant statistic difference (P0.05). MMF was found more effective in reducing proteinuria and retard the deterioration of renal function. Repeated biopsy data analysis revealed that vasculitic and proliferative lesions disappeared in MMF group. No significant change of membranous lesion was found in patients of both group. MMF was better tolerated with lower adverse reaction rate, such as pneumonia and upper gastrointestinal symptoms. No patient dropped out for side effect. Conclusion:The combined therapy of MMF and steroid is more effective and tolerable than CTX pulse therapy in the induction treatment of patient with LN(Ⅵ+Ⅴ). MMF was more effective in improving renal vasculitic lesion. No significant ascendancy in controlling membranous lesion was found in MMF treated patients.