| Title | Mycophenolate mofetil treatment of severe renal disease in pediatric onset systemic lupus erythematosus. | | Author(s) | Buratti S, Szer IS, Spencer CH, Bartosh S, Reiff A | | Institution | Department of Pediatrics, University of Southern California, Keck School of Medicine, Childrens Hospital Los Angeles, 90027, USA. | | Source | J Rheumatol 2001 Sep; 28(9):2103-8. | | MeSH | Administration, Oral
Adolescent
Child
Child, Preschool
Drug Administration Schedule
Drug Therapy, Combination
Female
Follow-Up Studies
Humans
Hydroxychloroquine
Kidney Function Tests
Lupus Erythematosus, Systemic
Lupus Nephritis
Male
Mycophenolic Acid
Prednisone
Research Support, Non-U.S. Gov't
Severity of Illness Index
Treatment Outcome
| | Abstract | OBJECTIVE: To report the first clinical experience with mycophenolate mofetil (MMF, CellCept) in: children with lupus nephritis.
METHODS: Eleven children with various forms of lupus nephritis were treated with oral MMF at a mean dose of 22 mg/kg/day (range 17-42) for a mean of 9.8 months (range 3-17). All children received concomitant prednisone and 7/11 were taking concomitant hydroxychloroquine. Indications for MMF included treatment refractory nephritis despite high dose oral or IV prednisone, azathioprine, and/or cyclophosphamide. Treatment outcome was monitored through assessment of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score, renal function, and serologic markers such as complement and anti dsDNA antibodies.
RESULTS: While renal function normalized in 4/4 patients with membranous glomerulonephritis, little effect was observed in children with proliferative glomerulonephritis. Ten children experienced a marked reduction in SLEDAI score. Anti-dsDNA antibody and serum complement levels improved or remained stable in 80% of the children. Concomitant prednisone was decreased in 6/11 patients (55%) without deterioration of renal function. Adverse events, observed in 8 patients (73%), were not dose dependent, and included infections, leukopenia, nausea, pruritus, headache, and fatigue.
CONCLUSION: MMF may represent a valuable alternative to traditional cytotoxic agents for children with class V lupus nephritis, but was less effective in attenuating disease progression in class IV glomerulonephritis. MMF had a steroid sparing effect and appeared to be effective in controlling serologic disease activity in pediatric onset SLE. Adverse events such as infections may limit its use and remain a concern. | | Language | eng | | Pub Type(s) | Clinical Trial
Journal Article
| | PubMed ID | 11550982 |
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