Efficacy Of Mycophenolate Mofetil Research Articles

Pediatric Idiopathic Nephrotic Syndrome: Treatment Strategies in Steroid Dependent and Steroid Resistant Forms

Idiopathic nephrotic syndrome (INS) is defined as massive proteinuria and hypoalbuminemia associated with dyslipidemia and generalized oedema in most cases. It is thought to be due to a plasma factor of immunologic origin. Most cases are steroid responsive. However, a considerable proportion of children run a steroid dependent course. Calcineurin inhibitors and alkylating agents have been classical treatment strategies for such cases, but specific toxicity limits the use of these drugs. Mycophenolate mofetil (MMF) is an inhibitor of inosine monophosphate dehydrogenase and thus de novo purine synthesis. Several uncontrolled clinical trials have demonstrated the efficacy of MMF in steroid dependent NS with or without prior use of CyP and in children with nephrotoxicity due to prolonged CyA treatment. Non-compliance to steroid therapy can be responsible for multiple relapses and may be misinterpreted as steroid dependency and may therefore lead to unjustified increase of immunosuppressive treatment. Triamcinolone acetonide, a long acting steroid for intramuscular injection, can replace the usual oral prednisone treatment if non-compliance is suspected. Whereas the treatment of the primary course of INS is well established, steroid dependent and steroid resistant forms are still a challenge for pediatric nephrologists. Both under-treatment with multiple relapses with disease or steroid associated morbidity on the one hand and over-treatment with specific side effects of immunosuppressive drugs may have severe consequences for the patients.

Is mycophenolate mofetil superior to pulse intravenous cyclophosphamide for induction therapy of proliferative lupus nephritis in Egyptian patients?

Recent studies have suggested that mycophenolate mofetil (MMF) may offer advantages over intravenous cyclophosphamide (IVC) for the treatment of lupus nephritis. The aim of this study was to evaluate the efficacy of MMF compared with IVC in the induction therapy of proliferative lupus nephritis. We randomly assigned 47 patients with newly diagnosed active proliferative lupus nephritis class III or IV to open-label oral MMF 2 g/day for 6 months or intravenous cyclophosphamide 0.5-1 g/m(2) monthly for 6 months in addition to corticosteroids. In the intention-to-treat analysis, 14 of the 24 patients (58.33%) receiving MMF and 12 of the 23 patients receiving cyclophosphamide (52.17%) had remission (P = 0.48); complete remission occurred in 6 of the 24 patients (25%) and 5 of the 23 patients (21.74%), respectively (P = 0.53). Improvements in packed cell volume, the erythrocyte sedimentation rate, anti-double-stranded DNA antibodies titer (anti-dsDNA), serum complement, proteinuria, urinary activity, renal function, serum soluble interleukin-2 receptor alpha concentration and the systemic lupus activity measure score were similar in both groups. Two patients assigned to MMF and another patient assigned to IVC developed end-stage renal failure with commencement of dialysis. Adverse events were similar. Major infections occurred in two patients in each group. There was no difference in gastrointestinal side effects, but more diarrhea occurred in those receiving MMF. In this 24-week trial, MMF or IVC combined with corticosteroids demonstrated equal efficacy in inducing remission of proliferative lupus nephritis.

Mycophenolate mofetil for localized scleroderma

Evaluation of: Martini G, Ramanan AV, Falcini F et al.: Successful treatment of severe or methotrexate-resistant juvenile localized scleroderma with mycophenolate mofetil. Rheumatology (Oxford) 48, 1410–1413 (2009). This retrospective study reports the outcome of mycophenolate mofetil (MMF) treatment in ten juvenile patients with severe or methotrexate-resistant localized scleroderma (two with pansclerotic morphea, five with linear scleroderma and three with generalized morphea). The clinical efficacy of MMF was assessed by clinical examination and thermography. The authors demonstrated efficacy of MMF in reducing the signs of inflammation, softening or lightening of skin lesions, which allowed reduction in dosage or withdrawal of corticosteroids and methotrexate in all patients. MMF was well tolerated and the investigators concluded that MMF is a valid alternative to methotrexate in arresting disease progression in juvenile localized scleroderma.

Genetic polymorphisms influence mycophenolate mofetil–related adverse events in pediatric heart transplant patients

Mycophenolate mofetil (MMF) is an effective and commonly used immunosuppressant but has frequent adverse events. Genetic polymorphisms may contribute to variability in MMF efficacy and related complications. In this study we explore the distribution frequencies of common single nucleotide polymorphisms (SNPs) of IMPDH1, IMPDH2 and ABCC2 and investigate whether these SNPs influence MMF adverse events in 59 pediatric heart recipients. Genotypes were assessed by TaqMan analysis of: ABCC2 rs717620; IMPDH2 rs11706052; and IMPDH1 rs2288553, rs2288549, rs2278293, rs2278294 and rs2228075. Gastrointestinal (GI) intolerance was defined as diarrhea, vomiting, nausea or abdominal pain requiring dose-holding for >48 hours or MMF discontinuation. Bone marrow toxicity was evaluated using Common Terminology Criteria for Adverse Events Version 3 (CTCAE). GI intolerance occurred in 21 patients, and 21 had bone marrow toxicity. The ABCC2 rs717620 A variant was significantly associated with GI intolerance leading to drug discontinuation (p < 0.001); the IMPDH1 rs2278294 A variant and rs2228075 A variant were also associated with greater GI intolerance (p = 0.029 and p = 0.002, respectively). The IMPDH2 rs11706052 G variant was associated with more frequent neutropenia requiring dose-holding (p = 0.046). In this small sample of pediatric heart transplant patients receiving MMF, ABCC2, IMPDH1 and IMPDH2 SNPs were associated with MMF GI intolerance and bone marrow toxicity. Thus, genetic polymorphisms may directly influence MMF adverse events.

Mycophenolate mofetil in Takayasu’s arteritis

Mycophenolate mofetil (MMf) has recently been reported as a useful alternative immunosuppressive drug in autoimmune diseases. There is paucity of literature on its use in Takayasu's arteritis (TA). The aim of this study was to assess the safety and efficacy of MMf in Asian Indian patients with Takayasu's arteritis. Records of 21 consecutive patients with TA on treatment with oral MMF attending our centre from January 2005 to August 2008 were studied. The clinical, laboratory and angiography findings were noted and disease activity assessment was done using Indian Takayasu's arteritis activity score (ITAS) and physician's global observation score at baseline and last follow-up. Eleven patients were on steroids alone at baseline while ten patients had received azathioprine prior to administration of mycophenolate. The mean duration of follow-up on mycophenolate was 9.6 (+/-6.4) months. Nineteen patients (90%) received mycophenolate due to active disease, while in the other two patients, it was given to facilitate steroid tapering. Mycophenolate had to be discontinued in one patient due to skin rash. At the last visit, all the remaining 20 patients who continued mycophenolate had improvement in disease activity as evident by the drop in median ITAS [7 (range 0-19) versus 1 (range 0-7); p=0.001]. A similar trend was noted in laboratory markers of inflammation with a reduction in mean Erythrocyte Sedimentation Rate (ESR) (68+/-36.5 versus 43.2+/-34 mm/first hour; p=0.003) and mean C - Reactive protein (CRP) (31+/-46.7 versus 17.3+/-23.9 mg/L; p=1.00). All patients received concomitant steroids, but there was a significant decrease in steroid dosage from 36 (+/-16) mg/day at baseline to 19 (+/-14) mg/day at last follow-up (p<0.001). This study is the largest series till date establishing the use of mycophenolate as a safe and effective steroid-sparing immunosuppressant in Takayasu's arteritis.

Mycophenolate Pharmacokinetics and Association with Response to Acute Graft-versus-Host Disease Treatment from the Blood and Marrow Transplant Clinical Trials Network

There are limited data as to the effectiveness of mycophenolate mofetil (MMF) plus high-dose corticosteroids for the treatment of acute graft-versus-host disease (aGVHD), and even less data regarding the pharmacokinetic disposition and exposure-response relationship of MMF in individuals with GVHD. MMF pharmacokinetics were studied in a multicenter Blood and Marrow Transplant Clinical Trials Network randomized phase II trial evaluating the effectiveness of MMF as one of 4 agents added to corticosteroids as treatment of aGVHD. Thirty-two of the patients randomized to receive MMF underwent pharmacokinetic sampling in weeks 1 and 2 were studied. Mean age was 41 +/- 13.6 years. Twenty one (65.6%), 5 (15.6%), 6 (18.8%) patients had a complete response (CR), partial response (PR) or lesser response by day 28, respectively. Twenty-five (78.1%), 2 (6.3%), 5 (15.6%) patients had a CR, PR, or other response by day 56 to treatment, respectively. Mycophenolic acid (MPA) pharmacokinetic measurements from weeks 1 and 2 did not correlate with CR at either day 28 or day 56 (P > .07); however, if the mean of weeks 1 and 2 total MPA troughs was >0.5 microg/mL or that of an unbound trough was >0.015 microg/mL, then a significantly greater proportion achieved CR + PR at days 28 and 56. CR + PR at day 28 was observed in 19 of 19 patients (100%) with a mean total trough >0.5 mg/mL, but in only 7 of 13 (54%) with a mean total trough < or =0.5 microg/mL (P = .002). Similarly, CR + PR at day 28 was seen in 15 of 15 patients (100%) with an unbound trough concentration >0.015 microg/mL, but in only 11 of 17 (65%) with an unbound trough concentration < or =0.015 microg/mL (P = .02). There was no association between the pharmacokinetic measures and risk of infection by day 90 or overall survival (OS) at day 180 postrandomization. About one-half of subjects did not achieve the favorable MPA total and unbound trough concentrations. The current practice of MMF 1 gm twice daily dosing provides low plasma concentrations in many patients. Higher doses may improve the efficacy of MMF as aGVHD therapy.

Long‐term mycophenolate mofetil treatment in pediatric renal transplant patients

AbstractOBJECTIVEClinical trials have demonstrated the safety and efficacy of mycophenolate mofetil (MMF) in reducing adult renal allograft rejection. We assessed the long‐term safety and efficacy of MMF in pediatric renal allograft recipients.METHODSIn this 3‐year, open‐label, dose‐ranging study, 40 patients received twice‐daily (bid) MMF 15, 23, or 30 mg/kg (to a maximum of 1,500 mg bid), cyclosporine, and corticosteroids. As 23 mg/kg MMF bid was shown to provide similar pharmacokinetics to the adult dosage of 1 g bid, this study was terminated after most patients had received treatment for 1 to 2 years. Thereafter, 33 patients were eligible to continue receiving MMF 23 mg/kg bid in a follow‐up study.RESULTSA total of 26 patients completed both studies (total follow‐up of up to 3 years post‐transplant). There were no deaths in either study; 2 graft losses occurred during the dose‐ranging study. The total 3‐year acute rejection rate for both studies was 42% (17/40 patients). All patients experienced 1 or more adverse events, but only 4 patients (10%) withdrew because of adverse events.DISCUSSIONLong‐term treatment with MMF was effective in preventing rejection and provided excellent patient and graft survival. Mycophenolate mofetil was well tolerated and had a safety profile consistent with that in adult renal allograft recipients.

The pharmacokinetics of mycophenolate mofetil in renal transplant recipients receiving standard-dose or low-dose cyclosporine, low-dose tacrolimus or low-dose sirolimus: the Symphony pharmacokinetic substudy

Exposure to mycophenolic acid (MPA), the primary active metabolite of mycophenolate mofetil (MMF), is correlated with therapeutic efficacy of MMF but varies depending on the concomitantly administered immunosuppressive drugs. A 3-month pharmacokinetic substudy of the prospective, randomized, multicentre, open-label Symphony study was performed. Eighty-three adult renal transplant patients received standard-dose cyclosporine, MMF 2 g/day and corticosteroids, or daclizumab induction, MMF 2 g/day and corticosteroids plus low-dose cyclosporine, low-dose tacrolimus or low-dose sirolimus. The area under the concentration-time curve (AUC(0-12)) of MPA and its metabolites between treatment groups was compared. Pharmacokinetic sampling was performed before MMF administration and at 20, 40, 75 min; 2, 3, 6, 8, 10 and 12 h post-dose on Day 7 and Months 1 and 3. Compared with standard-dose cyclosporine, patients receiving low-dose tacrolimus or low-dose sirolimus had significantly higher AUC(0-12) values for MPA at Day 7 and Month 1 and for free MPA at Day 7, and significantly lower AUC(0-12) values for 7-O-MPA-glucuronide (MPAG) at Month 1 and for acyl-glucuronide at Months 1 and 3 (P < 0.05). AUC(0-12) of MPA and free MPA was significantly greater with low-dose tacrolimus and low-dose sirolimus than with low-dose cyclosporine in the first month (P < 0.05). The ratio of MPA to MPAG exposure was significantly higher in the three low-dose groups than in the standard-dose cyclosporine group (P < 0.05). Standard- and low-dose cyclosporine reduces the exposure of MPA and free MPA compared to low-dose tacrolimus or low-dose sirolimus in patients given the same dose of MMF.

Membranous nephropathy in systemic lupus erythematosus: a therapeutic enigma

Renal disease is a major cause of mortality and morbidity in systemic lupus erythematosus. Among the histological classes of lupus nephritis, membranous nephropathy comprises only one-fifth of all cases. Reported survival and rates of end-stage renal disease in membranous lupus nephropathy (MLN) vary considerably, because of substantial heterogeneity among the published studies. The risk of progression from MLN to renal failure is generally reduced in the absence of proliferative lesions, but patients are, nevertheless, at risk of thromboembolic complications. The optimal therapy for MLN remains elusive because of a lack of controlled trials; however, cardiovascular protection and blockade of the renin-angiotensin system should be instituted early in all patients. Mixed membranous and proliferative lupus nephritis should be treated in the same way as pure proliferative lupus nephritis. If MLN is not accompanied by proliferative lesions but is associated with clinically relevant proteinuria, renal insufficiency or failure to respond to supportive therapies, immunosuppressive treatment is indicated. Treatment options include glucocorticoids combined with azathioprine, calcineurin inhibitors or alkylating agents. The efficacy of mycophenolate mofetil in MLN remains to be confirmed. Controlled trials to compare existing immunosuppressive agents and experimental modalities such as sirolimus, rituximab and infliximab should be undertaken in the future.

An update on the use of mycophenolate mofetil in lupus nephritis and other primary glomerular diseases

Mycophenolate mofetil (MMF) has been used successfully as an immunosuppressive medication in transplantation for over a decade. Owing to its efficacy and relatively benign adverse effect profile, its use has been investigated in the treatment of several glomerular diseases, as we describe in this Review. Of these, MMF has most extensively been studied in lupus nephritis. Randomized controlled trials have documented the value of MMF in both induction and maintenance therapy for severe lupus nephritis in several different geographic and ethnic populations, and have defined its potential toxicity. In minimal-change disease, focal segmental glomerulosclerosis and membranous nephropathy, promising but limited data on MMF treatment exist from small retrospective and prospective studies. Ongoing, larger, prospective trials, such as the NIH trial in focal segmental glomerulosclerosis, might clarify the value of MMF in the treatment of this disease. The efficacy of MMF in IgA nephropathy remains unclear, despite several small, controlled trials. Conflicting results might reflect differences in the disease process, differences in MMF metabolism, or varying responses to the immunosuppressive agent in different populations. Only through large, collaborative, controlled trials will the true role of MMF be defined for each glomerular disease.

Mycophenolate Mofetil Therapy for Sarcoidosis-Associated Uveitis

Purpose: To evaluate the control of ocular inflammation and the steroid sparing effect in patients with sarcoidosis-associated uveitis treated with mycophenolate mofetil (MMF). Methods: Retrospective case series. All patients with a diagnosis of sarcoidosis-associated uveitis that were treated with MMF between 2005 and 2007 were identified. The dose and duration of MMF therapy and side effects were recorded. Results: Seven patients (14 eyes) with sarcoidosis-associated uveitis were treated with MMF. The mean duration of treatment was 10 ± 4.7 months and the average time to control uveitis was 6.7 weeks. The flare-up rate was 51.5 per 100 person-years follow-up. The best-corrected mean logMAR VA revealed improvement in all 14 eyes. The efficacy of MMF in keeping disease activity under control was maintained in 6 patients. Conclusion: These data suggest that MMF is effective in controlling sarcoidosis-related ocular inflammation, has a corticosteroid sparing effect and a manageable side-effect profile.

Mycophenolate mofetil: safety and efficacy in the prophylaxis of acute kidney transplantation rejection

Mycophenolate mofetil (MMF), a prodrug of mycophenolic acid (MPA), is an inhibitor of inosine monophosphate dehydrogenase (IMPDH). It preferentially inhibits denovo pathway of guanosine nucleotide synthesis in T and B-lymphocytes and prevents their proliferation, thereby suppresses both cell mediated and humoral immune responses. Clinical trials in kidney transplant recipients have shown the efficacy of MMF in reducing the incidence and severity of acute rejection episodes. It also improves long term graft function as well as graft and patient survival in kidney transplant recipients. MMF is useful as a component of toxicity sparing regimens to reduce or avoid exposure of steroids or calcineurin inhibitor (CNI). Enteric-coated mycophenolate sodium (EC-MPS) can be used as an alternative immunosuppressive agent in kidney transplant recipients with efficacy and safety profile similar to MMF.

Mycophenolate mofetil in myasthenia gravis: the unanswered question

Myasthenia gravis (MG) is an autoimmune disease that leads to muscular weakness, which can significantly affect the patient's daily functions. If left untreated, the mortality rate can be as high as 30%. Effective immunosuppression is the cornerstone of treatment of MG, although most currently available immunomodulatory drugs are associated with unacceptable side effects, delayed onset of therapeutic action, or both. Mycophenolate mofetil (MMF) might be better tolerated than other immunosuppressants and many case reports and uncontrolled trials have indicated that it is effective in MG. However, two recently concluded clinical trials failed to demonstrate the efficacy of MMF in MG. This paper critically reviews the existing evidence on the efficacy of MMF in MG and provides the authors' view of its role in current practice.

The effect of mycophenolate mofetil on primary and secondary treatment of primary glomerulonephritis and lupus nephritis

Mycophenolate mofetil (MMF) has shown to be a reliable choice in the treatment of glomerulonephritis. We retrospectively reviewed the clinical course and response to MMF therapy in 49 patients with primary glomerulopathy (37 patients) and lupus nephritis [class III (five patients) and IV (seven patients)]. Patients were treated with MMF for more than 6 months as a primary (18 patients) or an adjunctive treatment (31 patients). Patients were also on methylprednisolone (2-20 mg/day) and angiotensin converting enzyme inhibitor/angiotensin receptor blocker. The mean age of the patient cohort was 33.69 +/- 12.4 years (range 19-59 years). Twenty-four-hour urinary protein excretion was reduced from 3.50 +/- 3.08 g prior to the commencement of MMF drug therapy to 1.21 +/- 1.44 and 0.99 +/- 1.34 g at the sixth and 12th months of MMF therapy, respectively (P < 0.05 for all). During this same period, significant increases in serum total protein (from 5.92 +/- 1.38 to 6.59 +/- 0.79 and 6.81 +/- 0.77 g/dl) and albumin levels (from 3.23 +/- 1.10 to 3.93 +/- 0.67 and 4.21 +/- 0.50 g/dl) were detected, whereas total cholesterol and low-density lipoprotein levels were found to be significantly decreased (P < 0.05 for all). Serum creatinine levels did not significantly change. The efficacy of MMF in reducing proteinuria was similar in both first line and an adjunctive therapy. The efficacy of MMF therapy began at the third month of treatment and continued through to the 12th month. Mycophenolate mofetil therapy was found to be useful in achieving improvements in proteinuria and nephrotic syndrome and stabilizing renal function. It was also a well-tolerated drug by the majority of the patients. Based on our results, we suggest that MMF may be alternative therapy for resistant/relapsing primary glomerulopathies and lupus nephritis.

Use of mycophenolate mofetil (MMF) in lupus nephritis (LN) in children

Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease; 86% of children with SLE have renal involvement, that ranges from asymptomatic urinary findings to nephritic syndrome and renal failure. Cyclophosphamide (CYC) and corticosteroids (CCS) has been the standard of care for many years, despite their failure or potential toxicities. Studies have showed good results with MMF in LN. We evaluated, in an observational study, the efficacy of MMF as induction and maintenance therapy in LN in children. Eighteen patients (15 female and 3 male, median age 12,2 ys) were evaluated with biopsy-proven LN, 13/18 received CYC or CCS as induction and then MMF, 5/18 received MMF plus CCS as from start. The following parameters were recorded at baseline and follow-up: serum creatinine, urinary protein excretion in 24 hours, full blood count, complement components (C3–C4), ANA positivity, ENA profile, SLEDAI score and histologic indices of activity and chronicity by Austin and coll. The median treatment time with MMF was 3 years. Our patients showed return in the range of normality of serum creatinine (p < 0,01), urinary protein excretion in 24 hours (p < 0,01), full blood count, complement components (C3–C4) (p < 0,01), ANA positivity (p < 0,01), ENA profile (p < 0,01), SLEDAI score (p < 0,01) and histologic indices of activity and chronicity (p < 0,01). In all patients CCS was suspended in 2 months. We had only 2 patients with adverse effects (1 diarrhoea, 1 viral infection). MMF as induction and manteinance therapy can be efficacy and safe in treatment of LN in children.

The role of mycophenolate mofetil in uveitis therapy

Abstract Purpose To summarize current evidences for mycophenolate mofetil (MMF) therapies in the treatment of uveitis. The review emphasizes the safety and efficacy of MMF in the treatment of inflammatory ocular diseases. Methods The review describes published research since early nineties, and reports the experience of a tertiary‐referral center. Results Studies in other disciplines have proven the efficacy of MMF with a long‐lasting remission in patients affected by Crohn’s disease, severe atopic dermatitis, Wegener’s granulomatosis, rheumatoid arthritis, pemphigus vugaris, and psoriasis. Recent publications have confirmed the satisfactory control of uveitis with MMF in a large cohort of patients. Severe ocular inflammations can also have late sequela, generated by the chronic damage to the retina: cystoid macular oedema (CMO) and choroidal neovascularization (CNV) can be late occurrences. MMF has been recently used for the control of such sequela, showing a promising role in the control of both CNV and CMO. Conclusion Non‐infectious uveitis is one of the leading causes of visual impairment in ophthalmology. Steroids can control such disease and its sequela, but a long‐term therapy with steroids could lead to complications such as high blood sugar level, osteoporosis, blood cell abnormalities, cataract and glaucoma. MMF is a reversible, non competitive, selective inhibitor of the de‐novo pathway of purine synthesis; mycophenolic acid has a strong effect to Type II isoform of inosine monophosphate dehydrogenase enzyme, providing a stronger cytostatic effect on lymphocytes than on other cells types, with minor action to Type I expressed in most other cells. The specific action of MMF on selected targets makes it a promising drug for the control of non‐infectious intraocular inflammations.

Lessons from Two Trials of Mycophenolate Mofetil in Myasthenia Gravis

Two randomized controlled trials of mycophenolate mofetil (MMF) in the treatment of myasthenia gravis (MG) were recently completed. Although neither study demonstrated efficacy of MMF in the population of patients studied, there are valuable lessons in the way these studies were developed and performed. After reviewing the design and results of these trials, we discuss possible reasons leading to negative results and the lessons learned, which should be useful for future clinical trials in MG.

Diagnostik und Therapie der Systemsklerose

Systemic sclerosis is a systemic autoimmune disease which still has a negative impact on overall survival. This especially holds true for the presence of pulmonary manifestations and/or pulmonary arterial hypertension. Cyclophosphamide is effective for pulmonary fibrosis, data also hint at an efficacy of mycophenolate mofetil. ACE inhibitors prevent renal crisis and endothelin antagonists and sildenafil improve pulmonary hypertension. Prostacyclin analogues are effective for the treatment of Raynaud`s phenomenon and digital ulcerations, which also can be prevented with bosentan. Otherwise, the data are sparse, there are few randomised studies with very small patient numbers. The present article summarises the studies on disease-modifying treatments and briefly reviews the symptomatic treatment options for Raynaud's phenomenon, ulcerations, calcifications, arthritis and gastrointestinal manifestations. Additionally, the recommended diagnostic measures and controls are reviewed.

Long-term control of cystoid macular oedema in noninfectious uveitis with Mycophenolate Mofetil

To evaluate the long-term safety and efficacy of Mycophenolate Mofetil (MMF) for the control of cystoid macular oedema (CMO) secondary to noninfectious uveitis (NU). The medical records of 19 consecutive patients with inflammatory CMO treated with MMF were retrospectively reviewed. Patient demographics, best corrected visual acuity (BCVA), fluorescein angiography (FA), and optical coherence tomography (OCT) findings were evaluated. There were eight females and 11 males with a mean age of 32.9 +/- 8.9 years. After a 1-year follow-up, 18/19 patients (31 eyes, 96.9%, P < 0.05) no longer had signs of CMO, as per their FA and OCT findings; the mean central foveal thickness (CFT) was 167.2 +/- 12.8 microm. At the last follow-up, only 3/19 patients, all affected by Behçet panuveitis, had recurrences of CMO. Mean BCVA improved from 0.34 +/- 0.14 SD at baseline to 0.65 +/- 0.2 SD at last follow-up. MMF was safe and effective in controlling CMO and in reducing the uveitis relapse rate in patients not responding to traditional immunosuppressants. Further case-controlled studies are mandatory to validate those preliminary results.

Mycophenolate Mofetil versus Azathioprine in the Maintenance Therapy of Lupus Nephritis

Background. Renal involvement is one of the major determinants of the outcome in patients with systemic lupus erythematosus. Renal involvement contributes to both morbidity and mortality of the patients as well as indirectly through side effects of therapy directed at the renal lesions. The aim of the study was to evaluate the efficacy of mycophenolate mofetil (MMF) and azathioprine (AZA) in the maintenance therapy of lupus nephritis. Methods. Thirty-two patients from our center with diagnosed lupus nephritis World Health Organization Class III, IV, V were treated with IVC (0.75–1g/month) for six months in addition to steroid therapy, and then with AZA (n = 15) or MMF (n = 17) as a maintenance therapy. The efficacy of two drugs was compared with changes in serum creatinine, creatinine clearance, 24 hour urine protein excretion, cholesterol, anti-dsDNA antibody, and urine sediment. Results. Mean follow-up time was 41.5 + 7 months. The total remission occurred in 84% of patients (82% with MMF and 87% with AZA), with a complete remission rate of 59.3% (58% with MMF and 60% with AZA) and a partial remission rate of 25% (22% with MMF and 27% with AZA). The urinary protein excretion before MMF treatment was 1.9 + 1 g/dL and decreased significantly to 0.91 + 0.6 g/dL (p = 0.028) after treatment, and decreased from 1.58 + 0.7g/dL to 0.4 + 0.23g/dL in the AZA group (p = 0.04). The serum creatinine level decreased from 1.32 + 0.7 mg/dL to 1.12 + 0.68 mg/dL in the MMF group (p = 0.23), and decreased from 0.91 + 0.23mg/dL to 0.88 + 0.23 mg/dL in the AZA group (p = 0.49). There was no significant change between two groups (p = 0.1). The serum cholesterol decreased from 229 + 57 mg/dL to 171 + 9 mg/dL (p = 0.002), and serum triglyceride level decreased from 228 + 116 mg/dL to 98 + 35 mg/dL (p = 0.004) in the MMF treatment, but no significant change was seen in AZA group. There was no significant difference between the two groups considering the rates of doubling of serum creatinine, progression to end-stage renal failure, relapses, and documented side effects, as well. Conclusion. Both therapeutic approaches with MMF or AZA, in combination with corticosteroids, are effective as a maintenance therapy for lupus nephritis.