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J Rheumatol. 2001 Sep;28(9):2103-8.

Mycophenolate mofetil treatment of severe renal disease in pediatric onset systemic lupus erythematosus.

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  • 1Department of Pediatrics, University of Southern California, Keck School of Medicine, Childrens Hospital Los Angeles, 90027, USA.

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.

PMID:
11550982
[PubMed - indexed for MEDLINE]
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