Mycophenolate Mofetil for Induction Treatment of Lupus Nephritis: A Systematic Review and Metaanalysis

Objective. To systematically review the efficacy and safety of mycophenolic acid and mycophenolate mofetil (MMF) compared to cyclophosphamide (CYC) for the induction treatment of lupus nephritis (LN). Methods. Medline, Embase, the Cochrane Center Register of Controlled Trials, and abstracts presented in major international conferences were searched for randomized controlled trials. The primary outcome was renal remission (complete, partial, and overall) and secondary outcomes were adverse events during study period and longterm followup data. Data were compared between groups and relative risk (RR) and 95% CI were calculated. Results. Four trials of a total of 618 patients were included. MMF was not superior to CYC for renal remission (partial RR 0.94,95% CI 0.80 to 1.12; complete RR 0.67,95% CI 0.35 to 1.28, and overall RR 0.89.95% CI 0.71 to 1.10). There was a significant reduction in alopecia (RR 5.77, 95% CI 1.56 to 21.38) and amenorrhea (RR 6.64,95% CI 2.00 to 22.07) with the use of MMF compared to CYC. These results should be interpreted with caution given the width of the CI. There was no significant difference for infections, leukopenia, gastrointestinal symptoms, herpes zoster, endstage renal disease, and death among groups during study period and longterm followup data. Conclusion. We could not show that MMF is superior to CYC for the induction treatment of LN. Patients treated with MMF showed reduced risk of certain side effects. MMF can be used as an alternative to CYC for the induction treatment of LN. (First Release Oct 15 2010; J Rheumatol 2011;38:69-78; doi:10.3899/jrheum.100130)