Haris Gul, Muhammad Salman Mushtaq, Babur Salim, Saba Samreen, Amjad Nasim, Muhammad Khan


Background: Lupus nephritis and its induction therapies are under studied subject in rheumatology especially in our population. The objective of this study is to compare the renal response to Mycophenolate mofetil (MMF) and Cyclophosphamide (CYC) as induction therapy in Pakistani population with lupus nephritis. Methods: This is a comparative retrospective study conducted at the department of rheumatology, Fauji Foundation Hospital (FFH), Rawalpindi and duration of study was 1.5 years from July 2016 to December 2017. The study includes 28 patients, all females, ages between 18 to 50 years. All have biopsy proven lupus nephritis (LN). All 28 LN patients have either stage III, IV, V. They were investigated and analysed over a period of 1.5 years. 14 patients were given MMF (2.5 gram/day) (MMF group) and 14 patients were given CYC (NIH protocol/monthly) (CYC group) for 24 weeks as induction therapy. Comparison of baseline characteristics, complete and partial renal responses to treatment was seen in the MMF and CYC groups. Results: Primary end point (complete response) is achieved in 6 (42.85%) in MMF group and 5 (35.71%) in the CYC group. Secondary end point (partial response) was achieved in 5 (35.71%) patients in the MMF group and 6(42.85%) in the CYC group. Difference in cumulative probability of complete and partial response was not statistically significant between the two groups (P-0.470 for CR) and (p-value 0.132 for PR). Conclusion: Mycophenolate mofetil is a new therapy for LN and it has equal efficacy as compared to CYC for LN induction.

Keywords: Lupus nephritis; Induction therapy; Mycophenolate Mofetil; Cyclophosphamide

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Firestein GS, Budd RC, Gabriel SE, McInnes, O’Dell JR. Kelly’s text book of rheumatology. 9th ed. St Louis: WB Saunders, 2012; p.1132–33.

Yu C, Gershwin ME, Chang C. Diagnostic criteria for systemic lupus erythematosus: a critical review. J Autoimmun 2014;48:10–3.

Rabbani MA, Tahir MH, Siddiqui BK, Ahmad B, Shamim A, Shah SM, et al. Renal Involvement in Systemic Lupus Erythematosus in Pakistan. J Pak Med Assoc 2005;55(8):328–32.

Raza MA, Khan MI. Systemic lupus erythematosus: disease manifestations in patients from Central Punjab (Pakistan). Int J Clin Rheumatol 2012;7(6):607.

Hernandez-Cruz B, Tapia N, Villa-Romero AR, Reyes E, Cardiel MH. Risk factors associated with mortality in systemic lupus erythematosus. A case control study in a tertiary care center in Mexico City. Clin Exp Rheumatol 2001;19(4):395–401.

Abu-Shakra M, Urowitz MB, Gladman DD, Gough J. Mortality studies in systemic lupus erythematosus. Results from a single center. II. Predictor variables for mortality. J Rheumatol 1995;22(7):1265–70.

Nossent JC. Systemic lupus erythematosus on the Caribbean Island of Curacao: An epidemiological investigation. Ann Rheum Dis 1992;51(11):1197–201.

Yap DY, Tang CS, Ma MK, Lam MF, Chan TM. Survival analysis and causes of mortality in patients with lupus nephritis. Nephrol Dial Transplant 2012;27(8):3248–54.

Hahn BH, Mcmahon MA, Wilkinson A, Wallace WD, Daikh DI, Fitzgerald JD, et al. American college of rheumatology guidelines for screening, treatment, and management of lupus nephritis. Arthrit Care Res 2012;64(6):797–808.

Appel GB, Contreras G, Dooley MA, Ginzler EM, Isenberg D, Jayne D, et al. Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis. J Am Soc Nephrol 2009;20(5):1103–12.

Sahay M, Saivani Y, Ismal K, Vali PS. Mycophenolate versus Cyclophosphamide for Lupus Nephritis. Indian J Nephrol 2018;28(1):35–40.

Markowitz GS, D’Agati VD. The ISN/RPS 2003 classification of lupus nephritis: An assessment at 3 years. Kidney Int 2007;71(6):491–5.

Goswami RP, Sircar G, Sit H, Ghosh A, Ghosh P. Cyclophosphamide Versus Mycophenolate Versus Rituximab in Lupus Nephritis Remission Induction: A Historical Head-to-Head Comparative Study. J Clin Rheumatol 2019;25(1):28–35.

Mendonca S, Gupta D, Ali S, Gupta P. Mycophenolate mofetil or cyclophosphamide in indian patients with lupus nephritis: Which is better? A single-center experience. Saudi J Kidney Dis Transpl 2017;28(5):1069–77.


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