Induction therapy for pediatric focal proliferative lupus nephritis: cyclophosphamide versus mycophenolate mofetil

J Pediatr Health Care. Sep-Oct 2008;22(5):282-8. doi: 10.1016/j.pedhc.2007.07.006. Epub 2008 Mar 4.

Abstract

Purpose of the study: Although cyclophosphamide has been used with success in children, mycophenolate may be a better alternative with less toxicity. The objective of this study is to determine the efficacy of mycophenolate compared with cyclophosphamide as induction therapy in children with class III lupus nephritis.

Methods: We retrospectively studied pediatric patients with class III lupus nephritis from two pediatric centers from January 1991 to December 2005 who were treated either with monthly cyclophosphamide or mycophenolate mofetil for the first 6 months. Thirteen patients were studied, with seven patients in the cyclophosphamide group and six patients in the mycophenolate group.

Results: At 6 months, in the cyclophosphamide group, no patient had achieved complete remission, while 57% were in partial remission. In the mycophenolate group, 66% had achieved complete remission, 17% were in partial remission, and 17% were not in remission.

Discussion: In a small group of children with class III lupus nephritis, we observed a trend of more patients in the mycophenolate group achieving remission at 6 months. However, the long-term benefit of using mycophenolate as an induction agent is still unclear.

Publication types

  • Comparative Study

MeSH terms

  • Administration, Oral
  • Adolescent
  • Analysis of Variance
  • Biopsy
  • Child
  • Cyclophosphamide / therapeutic use*
  • Drug Monitoring
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Infusions, Intravenous
  • Lupus Nephritis / classification
  • Lupus Nephritis / diagnosis
  • Lupus Nephritis / drug therapy*
  • Male
  • Mycophenolic Acid / analogs & derivatives*
  • Mycophenolic Acid / therapeutic use
  • Remission Induction / methods
  • Retrospective Studies
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Treatment Outcome

Substances

  • Immunosuppressive Agents
  • Cyclophosphamide
  • Mycophenolic Acid