Borba EF et al. (2006) Mycophenolate mofetil is effective in reducing lupus glomerulonephritis proteinuria. Rheumatol Int 26: 1078–1083

The optimum treatment for patients with membranous lupus nephritis is uncertain. Several therapeutic regimens have been suggested, including corticosteroids plus cyclophosphamide or chlorambucil; however, these regimens are associated with serious side effects. Mycophenolate mofetil reduces proteinuria in animal models of membranous nephropathy; Borba and colleagues, therefore, assessed the efficacy and tolerability of mycophenolate mofetil treatment of persistent proteinuria in patients with systemic lupus erythematosus (SLE).

In this 18-month pilot study, 20 patients with SLE and persistent isolated severe proteinuria or proteinuric flare (12 of whom had biopsy-proven membranous glomerulonephritis) received open-label mycophenolate mofetil 1.5 g daily for 1 month, escalated to a maximum of 3 g daily or until proteinuria decreased. At enrollment, all patients were taking antimalarial agents and angiotensin-converting-enzyme inhibitors, which were continued throughout the study. Immunosuppressive therapies other than prednisone were discontinued.

Mycophenolate mofetil was well tolerated and associated with few side effects. All patients achieved a partial response (a decrease in proteinuria of ≥50% from baseline) after a mean of 8.2 ± 3.3 months of 2.3 ± 0.5 g mycophenolate mofetil daily. An initial increase of proteinuria was observed in three patients at 4.6 ± 1.5 months; these patients responded to an intravenous dose of methylprednisolone and an increased dose of mycophenolate mofetil. Proteinuria had normalized (<0.3 g per 24 h) in 11 patients at 12.2 ± 3.0 months.

The authors concluded that mycophenolate mofetil could be an effective therapy for patients with SLE who experience persistent proteinuria. Prospective, randomized, controlled trials are warranted.