Mycophenolate mofetil vs. cyclophosphamide-based induction regimens for lupus nephritis: outcomes at a tertiary care centre in Lahore, Pakistan

Authors

  • Muhammad Ahmed Saeed Department of Rheumatology, Fatima Memorial Hospital, College of Medicine and Dentistry, Lahore, Pakistan https://orcid.org/0000-0003-4771-4441
  • Asadullah Khan Department of Rheumatology, Fatima Memorial Hospital, College of Medicine and Dentistry, Lahore, Pakistan
  • Faiza Naeem Department of Rheumatology, Fatima Memorial Hospital, College of Medicine and Dentistry, Lahore, Pakistan
  • Nighat Mir Ahmad Department of Rheumatology, Fatima Memorial Hospital, College of Medicine and Dentistry, Lahore, Pakistan

DOI:

https://doi.org/10.47391/JPMA.8694

Keywords:

Systemic lupus erythematous, Lupus nephritis, Mycophenolate mofetil, Cyclophosphamide

Abstract

Objective: To compare the efficacy of mycophenolate mofetil with intravenous cyclophosphamideas induction therapy in lupus nephritis.

Method: The observational, prospecrive,  cohort study was conducted at the Rheumatology Department of Fatima Memorial Hospital, Lahore, Pakistan, from July 2016 to June 2019, and comprised lupus nephritis patients. For induction therapy,  the patients were assigned at the discretion of the treating rheumatologist to mycophenolate mofetil group MMF, and intravenous cyclophosphamide group CYC. The later group was further divided into NIH subgroup that received the therapy as per the protocol of the  National Institutes of Health, and ELNT subgroup which recived the therapy as per the Euro Lupus Nephritis Trial protocol. Maintenance therapy in all groups was mycophenolate mofetil. Tacrolimus was added in case of non-response. The outcome was the achievement of complete renal response at 6, 12 and 24 months. Data was analysed using SPSS 26.

Results: Of the 131 patients, 126(96.2%) were females. The overall mean age was 27±7.7 years. There was 58(44.2%) patients in group MMF and 73(55.7%) in group CYC, which had subgroup NIH 46(63%) and subgrpup ELNT 27(37%). The complete renal response rates at 6, 12, and 24 months were 22 (43.1%), 35 (71.4%), and 40(83.3%) for group MMF; 5(12.5%), 9(22%) and 24 (58.5%) for subgroup NIH, and 6(26.1%), 8(36.4%) and 14(63.6%) for subgroup ELNT. Group MMF outcomes were significantly better than the rest (p<0.05).

Conclusion: Mycophenolate mofetil induction therapy was more effective than intraveenous cyclophosphamide in terms of achieving remission at 6, 12 and 24 months.

Key Words: Systemic lupus erythematous, Lupus nephritis, Mycophenolate mofetil, Cyclophosphamide.

Author Biography

Muhammad Ahmed Saeed, Department of Rheumatology, Fatima Memorial Hospital, College of Medicine and Dentistry, Lahore, Pakistan

Prof. Muhammad Ahmed Saeed
MBBS, FACP, FACR FCPS Internal Medicine FCPS Rheumatology
Professor and Head Department of Rheumatology  Institute of Rheumatic Diseases (IRD) Central Park Medical College, Lahore Consultant Rheumatologist, National Hospital and Medical Center Director and Consultant Rheumatologist, Arthritis Care Centre, Lahore Co-Chair and Founding Board Member, Arthritis Care Foundation www.arthritiscare.org.pk www.arthritiscarecentre.org

Published

2024-04-22

How to Cite

Saeed, M. A., Asadullah Khan, Faiza Naeem, & Nighat Mir Ahmad. (2024). Mycophenolate mofetil vs. cyclophosphamide-based induction regimens for lupus nephritis: outcomes at a tertiary care centre in Lahore, Pakistan. Journal of the Pakistan Medical Association, 74(5), 868–873. https://doi.org/10.47391/JPMA.8694

Issue

Section

RESEARCH ARTICLE