Rescue therapy in lupus nephritis patients with micophenolato mofetil

Authors

  • Viviana B Prettini Servicio de Nefrología y Medio Interno del Hospital Nacional de Clínicas, Universidad Nacional de Córdoba Servicio de Reumatología, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba
  • Avila López Gastón F Servicio de Nefrología y Medio Interno del Hospital Nacional de Clínicas, Universidad Nacional de Córdoba Servicio de Reumatología, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba
  • Ana M Sesín Servicio de Nefrología y Medio Interno del Hospital Nacional de Clínicas, Universidad Nacional de Córdoba Servicio de Reumatología, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba
  • Beatríz H Dotto Servicio de Nefrología y Medio Interno del Hospital Nacional de Clínicas, Universidad Nacional de Córdoba Servicio de Reumatología, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba
  • Marcelo Sanchez Freytes Servicio de Nefrología y Medio Interno del Hospital Nacional de Clínicas, Universidad Nacional de Córdoba Servicio de Reumatología, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba
  • Jorge Sesín Servicio de Nefrología y Medio Interno del Hospital Nacional de Clínicas, Universidad Nacional de Córdoba Servicio de Reumatología, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba
  • Juan C Vergottini Servicio de Nefrología y Medio Interno del Hospital Nacional de Clínicas, Universidad Nacional de Córdoba Servicio de Reumatología, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba

Keywords:

micofenolato mofetil, lupus nephritis, rescue treatment

Abstract

Long term cyclophosfamide combinated steroids therapy improves renal survival in  patients with Proliferate Lupus Nephritis, with considerable toxic effects. In lately years  MM?, a irnmune suppressor used in transplant, seems lo be effective in selected cases of  Lupus Nephritis.

Methods

We will describe six patients with Lupus Nephritis class IV and V (OMS Classification),  that what different causes they must be treated with MM? like rescue drug. This stabilizes  the renal funetion, controls LES activity and allows reductions or end of corticoids.

Results

In tree cases we achievement total remission, two show partial remission and we had a fail  because plaquetopenia and severe leucopenia with serious sepsis to give rise lo neumopaty;  this patient broke off the treatment. One presented Zoster Herpes that was treated wlth  ciclovir and temporary treatment break off.

Conclusion

MMF was effective to get remission in NL and maintain inactive LES, so it must to be  considering as rescue therapy, or maintenance treatment after cyclosphosfarnide induction.  In patients where fertility is important must be considering like eledive drug. Is necessary long time patients follow up to asses effectiveness in renal survival, like cyclophosfamide.

Downloads

Download data is not yet available.

References

Mc Cune,W joseph. Mycophenolate Mofetil Lupus Nefritis, NEJM 2005, 353:2282-2284.

Cameron JS. Lupus Nephritis. J Am. Soc. Nephrol. 1999; 10: 413-424.

F1k, RJ. com ed, Treatment of Lupus Nephritis-A work in progress, 2000, 343:1182-1183.

DooleyMA, HoganS, Jennette C, Falk RJ. Cyclophosphamide therapyfor lupus nephritis: poor renal survevival in black Americans. Kidneylnt 1997:51:1188-1195.

Steinberg AD, Steinberg SC. Longterm preservation of renal function in patients with lupus nephritis receiving tratment that incluyes cyclophosphamide versus those treated with prednisorie only. Arthritis Rheum 1991:34:945-950.

Allison AC, Eugul EM. Purtne metctbolism arid immunosuppressive effects micophenolate mophetil (MMF'). Clin Transplant 1996; 10:77-84.

Halloran P Mataew T, Tomlanovich S, Hooftrnan 1, Barker C, Groth C Mycophenolate mofetil in renal allograft recipienis: a pooled efficacy analysis of three randomized, double blind, clinical studies in prevenhion rejection. Transpiantation 1997;63:39-47

European Micophenolate Mofetil Cooperative Study Group. Placebo controlled study of micophenolate mofetil combined with cyclosporine and corticosteroids for preuention of acute rejection. Lancet 1999;345:1321-1325.

Austin HA III, Klippel JH, et al. Therapy of lupus nephritis controlled trial of prednisone and cytotoxic drugs. NEJM 1986,314:614-9.

Houssian FA, Vasconcelos C, D'Cruz D, et al. Inrnunosuppresive therapy in lupus nephritis: the Euro - Lupus Nephritis Trial, a randomized trial of low-dose versus high - dose intravenus cyclophosphamide. Arthritis Rheum 2002; 46:2121-31.

Houssian FA, Vasconcelos C, DCruz D, et al. Early response to immunosuppresive therapy predicts good renal outcome un lupus nephritis lessons from long - lerm followup of patients in the Euro - Lupus Neprithis Trial. Arthritis Rheum 2004; 50: 3934-40.

Ellen M.Ginzer, Dooley Mary Anne, et al. Micophenolate mofetil or intravenis cyclophospamide for lupus nephitis. 2005, 353:2219-28

Hu W, Li KF. Chen H. et al. Mycoplieriolate mofetil es. Cyclophosphamide therapy for patients with d[fuse prolferative lupus nephritis. Clin Med J 2002; 115: 705-709.

Contreras G., Pardo V. Sequential therapies for proliferalive lupus nephritis. NEJM 2004: 350:971-982.

Mok CC, La¡ EN Mycophenolate Mofetil inlupus glomerulonephritis. Am J Kidney Dis.2002;4:447-457.

Pisoni CN, Sanchez F Karim Y, et al. Mycophenolate Mofetil in Systemic Lupus Erythematosus: Efficacy and Tolerability in 86 Patients. The journal of Rheumatology 2005; 32:6 1047-52.

Suárez LF.Remission of Severe Relapsing or persistent lupus nephritis uing mycophenolate mofetil. Arch.Of Medical Reseach 2006; 37:68-73.

Illei GG, Takada K, Parkin D. et al. Renal fiares are cornmon in patients with severe proliferative lupus nephritis treated with pulse immunosuppressive therapy: long term followup of cohort of 142 patrients participaiting in rabdomized controlled studies. Artthritis Rheum 2002; 46:995-1002.

Downloads

Published

2019-11-19

How to Cite

1.
Prettini VB, Gastón F AL, Sesín AM, Dotto BH, Sanchez Freytes M, Sesín J, Vergottini JC. Rescue therapy in lupus nephritis patients with micophenolato mofetil. Rev Fac Cien Med Univ Nac Cordoba [Internet]. 2019 Nov. 19 [cited 2024 Jul. 6];63(3):39-46. Available from: https://revistas.unc.edu.ar/index.php/med/article/view/26453

Issue

Vol. 63 No. 3 (2006)

Section

Original Papers

License

The Faculty of Medical Sciences Journal (RFCM) subscribes to the Open Access policy and does not charge authors fees for publishing, nor does it charge readers fees for accessing published articles (APC).