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Published ahead of print on August 8, 2007
Clin J Am Soc Nephrol 2: 968-975, 2007
© 2007 American Society of Nephrology
doi: 10.2215/CJN.01200307
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Epidemiology and Outcomes

Mycophenolate Mofetil for Induction Therapy of Lupus Nephritis: A Systematic Review and Meta-Analysis

Michael Walsh*,{dagger}, Matthew James*, David Jayne{ddagger}, Marcello Tonelli§,||,¶, Braden J. Manns*,{dagger},¶, and Brenda R. Hemmelgarn*,{dagger}

Departments of * Medicine and {dagger} Community Health Sciences, University of Calgary, Calgary, and Departments of § Medicine and || Critical Care, University of Alberta, and Institute of Health Economics, Edmonton, Alberta, Canada; and {ddagger} Renal Unit, Addenbrooke's Hospital, Cambridge, United Kingdom

Address correspondence to: Dr. Michael Walsh, Lupus and Vasculitis Clinic, Box 118, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ, United Kingdom. Phone: +223-217-259; Fax: +223-586-796; E-mail: mwwalsh{at}ucalgary.ca

Background and Objectives: Although the accepted standard of care for induction of lupus nephritis has been cyclophosphamide, recent trials suggest that mycophenolate mofetil may be as or more effective and less toxic. A systematic review and meta-analysis were performed to determine the risk for failure to induce remission of lupus nephritis in patients who were treated with mycophenolate mofetil compared with cyclophosphamide.

Design, Setting, Participants, & Measurements: Studies were identified by a search of electronic databases, bibliographies, and conference proceedings and by contacting experts. Randomized trials that compared mycophenolate mofetil with cyclophosphamide for induction therapy in adults with biopsy-proven lupus nephritis were eligible. The primary outcome was failure to induce a remission of nephritis as defined by the original studies (based on proteinuria, renal function, and urine sediment).

Results: Four studies that included 268 patients and had homogeneous results across studies were identified. In a fixed-effects model, the pooled relative risk for failure to induce remission for mycophenolate mofetil compared with cyclophosphamide was 0.70. The relative risk for the composite outcome of death or end-stage renal disease for mycophenolate mofetil compared with cyclophosphamide was 0.44. Leukopenia and amenorrhea occurred more frequently in cyclophosphamide-treated patients.

Conclusions: Treatment of lupus nephritis with mycophenolate mofetil compared with cyclophosphamide reduces the risk for failure to induce remission during induction therapy and may reduce the risk for death or end-stage renal disease. Mycophenolate mofetil may be considered as a first-line induction therapy for the treatment of lupus nephritis in patients without severe renal dysfunction.


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