TY - JOUR
T1 - The Effect of Mycophenolate Mofetil as First-Line Therapy on the Timing of Urine Protein-to-Creatinine Ratio Reduction in Immunosuppressant-Naive PatientsWith Lupus Nephritis at a Single Center
AU - Timlin, Homa
AU - Hardenbergh, Dylan
AU - Fine, Derek
AU - Monroy-Trujillo, Jose Manuel
AU - Haque, Uzma
AU - Adler, Brittany
AU - Vaidya, Dhananjay
AU - Geetha, Duvuru
N1 - Funding Information:
The material contained within this manuscript has not been published or submitted for publication elsewhere. Financial support for this research comes from the Johns Hopkins Institute for Clinical and Translational Research, which is funded in part by grant number UL1 TR003098 from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health, and the National Institutes of Health Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins Institute for Clinical and Translational Research, National Center for Advancing Translational Sciences, or National Institutes of Health.
Funding Information:
Dr Duvuru Geetha is a consultant to ChemoCentryx and Aurinia. Dr Dhananjay Vaidya has received a grant from the American Heart Association. The remaining authors have no relevant conflicts of interest.
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/1/1
Y1 - 2022/1/1
N2 - Background/Objectives: Early response to immunosuppressive therapy predicts good renal outcome in lupus nephritis (LN). The purpose of this study was to assess the effect of mycophenolate mofetil (MMF) on the timing of urine protein-to-creatinine ratio reaching 200 mg or less after starting MMF as initial therapy for class III, IV, or V in immunosuppressant-naive patients with LN. Methods: Patients who had a diagnosis of biopsy-proven LN were included in this cohort study. The initial dose of MMF was 1000 mg twice daily. If no improvement, it was increased to 1500 mg twice daily after 1 month. For statistical analysis, exact binomial distribution 95% confidence intervals were calculated. Results: Nine patients were identified. There were 3 patients with class III, 3 with class IV, 1 with class III to V, 1 with class II to V, and 1 with class V lupus nephritis. The majority were African Americans (70%). At baseline, proteinuria ranged between 0.41 and 4 g, and 88% had normal estimated glomerular filtration rate. Forty-four percent of patients reached 0.28 g of proteinuria within 8 weeks of startingMMF (95% confidence interval, 14%-79%), all of which maintained the same level of response and normal estimated glomerular filtration rate at 12 months. Thirty-three percent of patients achieved the American College of Rheumatology complete response at 8 weeks. Conclusions: This study demonstrates that only a minority of immunosuppressant-naive LN patients achieved the American College of Rheumatology complete response at 8 weeks after initiation ofMMF. A rapid decline in the proteinuria to 0.28 g within the first 8 weeks of the treatment correlated strongly with achieving the same level of response at 12 months.
AB - Background/Objectives: Early response to immunosuppressive therapy predicts good renal outcome in lupus nephritis (LN). The purpose of this study was to assess the effect of mycophenolate mofetil (MMF) on the timing of urine protein-to-creatinine ratio reaching 200 mg or less after starting MMF as initial therapy for class III, IV, or V in immunosuppressant-naive patients with LN. Methods: Patients who had a diagnosis of biopsy-proven LN were included in this cohort study. The initial dose of MMF was 1000 mg twice daily. If no improvement, it was increased to 1500 mg twice daily after 1 month. For statistical analysis, exact binomial distribution 95% confidence intervals were calculated. Results: Nine patients were identified. There were 3 patients with class III, 3 with class IV, 1 with class III to V, 1 with class II to V, and 1 with class V lupus nephritis. The majority were African Americans (70%). At baseline, proteinuria ranged between 0.41 and 4 g, and 88% had normal estimated glomerular filtration rate. Forty-four percent of patients reached 0.28 g of proteinuria within 8 weeks of startingMMF (95% confidence interval, 14%-79%), all of which maintained the same level of response and normal estimated glomerular filtration rate at 12 months. Thirty-three percent of patients achieved the American College of Rheumatology complete response at 8 weeks. Conclusions: This study demonstrates that only a minority of immunosuppressant-naive LN patients achieved the American College of Rheumatology complete response at 8 weeks after initiation ofMMF. A rapid decline in the proteinuria to 0.28 g within the first 8 weeks of the treatment correlated strongly with achieving the same level of response at 12 months.
KW - Mycophenolate mofetil
KW - Proteinuria
KW - Systemic lupus erythematosus
KW - Urine protein-to-creatinine ratio
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U2 - 10.1097/RHU.0000000000001656
DO - 10.1097/RHU.0000000000001656
M3 - Article
C2 - 33394827
AN - SCOPUS:85122387076
SN - 1076-1608
VL - 28
SP - E141-E144
JO - Journal of Clinical Rheumatology
JF - Journal of Clinical Rheumatology
IS - 1
ER -