Mycophenolate mofetil versus cyclophosphamide, in combination with prednisolone for lupus nephritis induction treatment: Findings from a prospective observational study
Background: Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus. Intravenous cyclophosphamide (CYC) is the standard induction therapy for proliferative LN, but it is associated with serious adverse effects such as sterility and bone marrow suppression. Mycophenolate mofetil...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Manipal College of Medical Sciences, Pokhara
2025-07-01
|
| Series: | Asian Journal of Medical Sciences |
| Subjects: | |
| Online Access: | https://ajmsjournal.info/index.php/AJMS/article/view/4589 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850093611459280896 |
|---|---|
| author | Rakhesh LR Priya S Raju Rajesh Wilson Bindu Latha Nair R Sanitha Kuriachan Mahesh Kumar D Jumi Jacob |
| author_facet | Rakhesh LR Priya S Raju Rajesh Wilson Bindu Latha Nair R Sanitha Kuriachan Mahesh Kumar D Jumi Jacob |
| author_sort | Rakhesh LR |
| collection | DOAJ |
| description | Background: Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus. Intravenous cyclophosphamide (CYC) is the standard induction therapy for proliferative LN, but it is associated with serious adverse effects such as sterility and bone marrow suppression. Mycophenolate mofetil (MMF) has emerged as a promising alternative, offering better renal outcomes and preserving fertility in women of childbearing age.
Aims and Objectives: To compare the treatment outcomes and safety of MMF plus prednisolone versus CYC plus prednisolone in the induction treatment of LN.
Materials and Methods: Patients with Class 3 and 4 LN who received either oral MMF (2 g/day) or CYC (0.75–1 g/m2) were included in the study. Remission rates and adverse events were measured as treatment outcomes.
Results: The study found 81% remission in the MMF group compared to 76.4% in the CYC group (not statistically significant). Adverse effects in the MMF group included headache (52.4%), bone marrow toxicity (47.6%), back pain (42.9%), and gastrointestinal side effects (42.8%). The CYC group had higher rates of bone marrow toxicity (57.1%), respiratory infections (33.3%), and mucocutaneous infections (57.1%). Notably, alopecia (4.8% vs. 52.4%, P=0.001) and amenorrhea (4.8% vs. 28.6%, P=0.04) were significantly lower in the MMF group.
Conclusion: The MMF-steroid regimen is highly effective for inducing remission in proliferative LN and offers a more favorable safety profile than the CYC-steroid regimen. |
| format | Article |
| id | doaj-art-3e576baf8d474c3192db30022374fa88 |
| institution | DOAJ |
| issn | 2467-9100 2091-0576 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Manipal College of Medical Sciences, Pokhara |
| record_format | Article |
| series | Asian Journal of Medical Sciences |
| spelling | doaj-art-3e576baf8d474c3192db30022374fa882025-08-20T02:41:52ZengManipal College of Medical Sciences, PokharaAsian Journal of Medical Sciences2467-91002091-05762025-07-01167105109https://doi.org/10.71152/ajms.v16i7.4589Mycophenolate mofetil versus cyclophosphamide, in combination with prednisolone for lupus nephritis induction treatment: Findings from a prospective observational studyRakhesh LR 0https://orcid.org/0009-0000-4809-3910Priya S Raju 1https://orcid.org/0009-0008-8964-0341Rajesh Wilson 2https://orcid.org/0000-0003-0558-6883Bindu Latha Nair R 3Sanitha Kuriachan 4https://orcid.org/0000-0002-2711-9816Mahesh Kumar D 5https://orcid.org/0000-0002-0535-601XJumi Jacob 6https://orcid.org/0009-0002-0763-1975Associate Professor, Department of Pharmacology, Dr. Moopen’s Medical College, Wayanad, Kerala, India Associate Professor, Department of Obstetrics and Gynecology, Dr. Moopen’s Medical College, Wayanad, Kerala, India Assistant Professor, Department of Biochemistry, Karuna Medical College, Palakkad, Kerala, India Professor, Department of Pharmacology, Government Medical College, Thiruvananthapuram, Kerala, IndiaProfessor, Department of Pharmacology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India Associate Professor, Department of Pharmacology, Amrita Institute of Medical Sciences, Kochi, Kerala, India Associate Professor, Department of Pharmacology, Sree Uthradom Thirunal Academy of Medical Sciences, Vencode, Vattappara, Thiruvananthapuram, Kerala, India Background: Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus. Intravenous cyclophosphamide (CYC) is the standard induction therapy for proliferative LN, but it is associated with serious adverse effects such as sterility and bone marrow suppression. Mycophenolate mofetil (MMF) has emerged as a promising alternative, offering better renal outcomes and preserving fertility in women of childbearing age. Aims and Objectives: To compare the treatment outcomes and safety of MMF plus prednisolone versus CYC plus prednisolone in the induction treatment of LN. Materials and Methods: Patients with Class 3 and 4 LN who received either oral MMF (2 g/day) or CYC (0.75–1 g/m2) were included in the study. Remission rates and adverse events were measured as treatment outcomes. Results: The study found 81% remission in the MMF group compared to 76.4% in the CYC group (not statistically significant). Adverse effects in the MMF group included headache (52.4%), bone marrow toxicity (47.6%), back pain (42.9%), and gastrointestinal side effects (42.8%). The CYC group had higher rates of bone marrow toxicity (57.1%), respiratory infections (33.3%), and mucocutaneous infections (57.1%). Notably, alopecia (4.8% vs. 52.4%, P=0.001) and amenorrhea (4.8% vs. 28.6%, P=0.04) were significantly lower in the MMF group. Conclusion: The MMF-steroid regimen is highly effective for inducing remission in proliferative LN and offers a more favorable safety profile than the CYC-steroid regimen.https://ajmsjournal.info/index.php/AJMS/article/view/4589lupus nephritis; mycophenolate mofetil; remission induction; cyclophosphamide; side effects |
| spellingShingle | Rakhesh LR Priya S Raju Rajesh Wilson Bindu Latha Nair R Sanitha Kuriachan Mahesh Kumar D Jumi Jacob Mycophenolate mofetil versus cyclophosphamide, in combination with prednisolone for lupus nephritis induction treatment: Findings from a prospective observational study Asian Journal of Medical Sciences lupus nephritis; mycophenolate mofetil; remission induction; cyclophosphamide; side effects |
| title | Mycophenolate mofetil versus cyclophosphamide, in combination with prednisolone for lupus nephritis induction treatment: Findings from a prospective observational study |
| title_full | Mycophenolate mofetil versus cyclophosphamide, in combination with prednisolone for lupus nephritis induction treatment: Findings from a prospective observational study |
| title_fullStr | Mycophenolate mofetil versus cyclophosphamide, in combination with prednisolone for lupus nephritis induction treatment: Findings from a prospective observational study |
| title_full_unstemmed | Mycophenolate mofetil versus cyclophosphamide, in combination with prednisolone for lupus nephritis induction treatment: Findings from a prospective observational study |
| title_short | Mycophenolate mofetil versus cyclophosphamide, in combination with prednisolone for lupus nephritis induction treatment: Findings from a prospective observational study |
| title_sort | mycophenolate mofetil versus cyclophosphamide in combination with prednisolone for lupus nephritis induction treatment findings from a prospective observational study |
| topic | lupus nephritis; mycophenolate mofetil; remission induction; cyclophosphamide; side effects |
| url | https://ajmsjournal.info/index.php/AJMS/article/view/4589 |
| work_keys_str_mv | AT rakheshlr mycophenolatemofetilversuscyclophosphamideincombinationwithprednisoloneforlupusnephritisinductiontreatmentfindingsfromaprospectiveobservationalstudy AT priyasraju mycophenolatemofetilversuscyclophosphamideincombinationwithprednisoloneforlupusnephritisinductiontreatmentfindingsfromaprospectiveobservationalstudy AT rajeshwilson mycophenolatemofetilversuscyclophosphamideincombinationwithprednisoloneforlupusnephritisinductiontreatmentfindingsfromaprospectiveobservationalstudy AT bindulathanairr mycophenolatemofetilversuscyclophosphamideincombinationwithprednisoloneforlupusnephritisinductiontreatmentfindingsfromaprospectiveobservationalstudy AT sanithakuriachan mycophenolatemofetilversuscyclophosphamideincombinationwithprednisoloneforlupusnephritisinductiontreatmentfindingsfromaprospectiveobservationalstudy AT maheshkumard mycophenolatemofetilversuscyclophosphamideincombinationwithprednisoloneforlupusnephritisinductiontreatmentfindingsfromaprospectiveobservationalstudy AT jumijacob mycophenolatemofetilversuscyclophosphamideincombinationwithprednisoloneforlupusnephritisinductiontreatmentfindingsfromaprospectiveobservationalstudy |