Study: Mycophenolate is superior to azathioprine as treatment for lupus nephritis

November 16, 2011
Mary Anne Dooley, M.D., MPH, is first author of the study, which is published in the New England Journal of Medicine. Credit: UNC Rheumatology/Thurston Arthritis Research Center

A new large, international study finds that the immunosuppressant drug mycophenolate mofetil is superior to azathioprine, an older immunosuppressant, as a maintenance therapy for lupus nephritis.

"This is a huge step forward for people who suffer from lupus nephritis," said Mary Anne Dooley, MD, MPH, associate professor in the University of North Carolina at Chapel Hill School of Medicine and first author of the study, which is published in the Nov. 17, 2011 issue of the .

Lupus nephritis is an inflammation of the kidney caused by (SLE), a disease of the immune system. Lupus nephritis may cause weight gain, high blood pressure, dark urine, or swelling around the eyes, legs, ankles, or fingers. In some patients the inflammation may be severe enough to cause . However, some people with SLE have no symptoms of kidney disease.

The new study adds one more badly needed drug to the arsenal that physicians can use to treat lupus, Dooley said. In addition, it should help persuade to pay for the drug when it is used as for lupus nephritis. Some insurers have refused to cover it because the drug is not FDA-approved for that indication, she said.

Both mycophenolate mofetil and azathioprine have been FDA-approved since the mid-1990s for use in , to help prevent . Neither is FDA-approved as a maintenance therapy for , but their immunosuppressant qualities make them useful for that purpose and physicians have been prescribing them off-label for that indication for many years.

The study included 227 patients who had previously responded well to an earlier round of treatment, called induction therapy. The patients were enrolled at 71 centers in 19 countries in Asia, Australia, Europe, North America, Latin America and South Africa. Researchers followed the patients for three years (36 months), with 116 receiving mycophenolate mofetil twice a day while 111 received azathioprine twice a day.

The results showed that mycophenolate mofetil was superior in virtually every aspect to azathioprine. There was a 16.4 percent treatment failure rate in the mycophenolate group, compared to 32.4 percent in the azathioprine group. Patients responded well to mycophenolate for a longer period of time than patients on azathioprine, and negative side effects were more common with azathioprine.

This study also found that African-American patients in particular responded better to mycophenylate mofetil than to cyclophosphamide (Cytoxan) as an induction therapy and better than azathioprine as a maintenance treatment, Dooley said.

Explore further: 'Multi-target' immune therapy improves outcomes of severe lupus nephritis

Related Stories

Rituximab reduces kidney inflammation in patients with lupus

March 4, 2009

Treatment with the targeted drug rituximab can significantly benefit some patients with severe lupus nephritis who do not respond to conventional therapy, according to a study appearing in an upcoming issue of the Clinical ...

Alternative therapy for lupus nephritis

April 15, 2009

Lupus is a rare but serious disease that mainly affects women of child-bearing age and occurs when the body's immune system goes awry, damaging a variety of organs. When kidneys are targeted, patients develop lupus nephritis, ...

Kidney transplants generally safe for lupus patients

November 2, 2009

Individuals with a history of lupus who receive a kidney transplant rarely develop the serious inflammatory condition lupus nephritis in their new organ, according to a paper being presented at the American Society of Nephrology's ...

Recommended for you

Zika virus may persist in the vagina days after infection

August 25, 2016

The Zika virus reproduces in the vaginal tissue of pregnant mice several days after infection, according to a study by Yale researchers. From the genitals, the virus spreads and infects the fetal brain, impairing fetal development. ...

In sub-Saharan Africa, cancer can be an infectious disease

August 26, 2016

In 1963, Irish surgeon Denis Parson Burkitt airmailed samples of an unusual jaw tumor found in Ugandan children to his colleague, Anthony Epstein, at Middlesex Hospital in London. Epstein, an expert in chicken viruses and ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.