Yong Patrick Fk, D'Cruz David P
Department of Clinical Immunology, Kings College Hospital.
Biologics. 2008 Jun;2(2):297-310. doi: 10.2147/btt.s2266.
Lupus nephritis is a complication of systemic lupus erythematosus, which has significant morbidity and mortality. The accepted standard of treatment for severe lupus nephritis is cyclophosphamide for induction of remission. This has significant adverse effects including severe infection and amenorrhea. In addition, although cyclophosphamide induces remission, long-term mortality does not seem to be altered. Mycophenolate mofetil (MMF) is an immunosuppressive agent originally used in solid organ transplantation, which has been compared with cyclophosphamide in trials for lupus nephritis. Randomized trials with MMF have been relatively small, although pooled data seem to suggest that it is at least as effective as cyclophosphamide in inducing remission. In addition, MMF has also been associated with a reduced risk of infection and amenorrhea, although this finding is not universal. MMF appears to be associated with more diarrhea compared with cyclophosphamide. MMF is likely to be a useful treatment for lupus nephritis, although available trial data are limited due to the small size of previous studies. A large trial (the Aspreva Lupus Management Study) is currently underway to attempt to establish the place of MMF in treatment of lupus nephritis.
狼疮性肾炎是系统性红斑狼疮的一种并发症，具有较高的发病率和死亡率。重度狼疮性肾炎公认的治疗标准是使用环磷酰胺诱导缓解。这会产生显著的不良反应，包括严重感染和闭经。此外，尽管环磷酰胺能诱导缓解，但长期死亡率似乎并未改变。霉酚酸酯（MMF）是一种最初用于实体器官移植的免疫抑制剂，在狼疮性肾炎试验中已与环磷酰胺进行了比较。MMF的随机试验规模相对较小，尽管汇总数据似乎表明其在诱导缓解方面至少与环磷酰胺一样有效。此外，MMF还与感染和闭经风险降低有关，尽管这一发现并不普遍。与环磷酰胺相比，MMF似乎与更多的腹泻有关。MMF可能是狼疮性肾炎的一种有效治疗方法，尽管由于先前研究规模较小，现有试验数据有限。一项大型试验（阿斯普雷瓦狼疮管理研究）目前正在进行，试图确定MMF在狼疮性肾炎治疗中的地位。
