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Ann Rheum Dis. 2003 Jun; 62(6): 534–539.
PMCID: PMC1754566

Mycophenolate mofetil prevents a clinical relapse in patients with systemic lupus erythematosus at risk


Background: Systemic lupus erythematosus (SLE) is characterised by the presence of antibodies to double stranded DNA (dsDNA), which are involved in the pathogenesis of SLE. Previous studies showed that at least two thirds of patients develop a clinical relapse within six months after a significant rise in the anti-dsDNA level, and most relapses were prevented by the administration of corticosteroids at the time of the rise.

Objective: To determine whether mofetil mycophenolate (MMF) can prevent a clinical relapse without the side effects associated with corticosteroids.

Methods: 36 patients with SLE were examined monthly to determine whether a rise in anti-dsDNA level had occurred. A rise was defined as an increase of 25% of the level of the previous sample of at least 15 IU/ml within a four month period. After a rise patients were treated with MMF 2000 mg daily for six months. Patients were monitored monthly for the occurrence of a clinical relapse and to assess the serological activity and state of activation of CD4+, CD8+, and CD19+ lymphocyte subsets.

Results: Anti-dsDNA rose in 10 patients. Treatment with MMF was started in all these patients, and after six months no clinical relapse had occurred. Side effects were minimal. Antibodies to dsDNA decreased during the treatment (p<0.001), associated with a decrease in the state of activation of CD19+ lymphocytes. No changes were found in the state of activation of CD4+ or CD8+ lymphocyte subsets.

Conclusion: Administration of MMF after a rise in antibodies to dsDNA is well tolerated, decreases anti-dsDNA and B cell activation, and seems to prevent the occurrence of a clinical relapse in patients with SLE.

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Selected References

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Figures and Tables

Figure 1
(A) SLEDAI score of 10 patients during a six month period of treatment with MMF after a significant rise in the level of antibodies to dsDNA. (B) VAS-Pa and (C) VAS-Ph represent the impression of the patient and the treating physician, respectively, ...
Figure 2
Levels of antibodies to dsDNA of each patient are shown from two months before the significant rise was established at t=0, until six months thereafter. MMF was started at t=0 and continued for six months (A). For each participant, levels of total IgG ...
Figure 3
Activation state of lymphocytes during six months of treatment with MMF. (A) Activation state of CD4+ lymphocytes depicted as the percentage of these cells staining positive for the activation marker CD25. (B) Activation state of CD8+ lymphocytes depicted ...

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