Section of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, National Cheng-Kung University Medical College and Hospital, Tainan, Taiwan, Republic of China.
Clin Rheumatol. 2010 Jul;29(7):771-5. doi: 10.1007/s10067-010-1403-9. Epub 2010 Mar 2.
Mycophenolate mofetil (MMF) has recently been introduced as an immunosuppressive agent for the treatment of glomerulonephritis with systemic lupus erythematosus (SLE) and the data have been encouraging. However, response to MMF treatment appears to differ ethnically. Therefore, we determined efficacy and safety of low-dose MMF for Taiwanese patients with lupus nephritis. We studied 36 lupus nephritis patients who were treated with MMF. The dose started at 0.5 g/day and we collected the data from patients who received up to 1 g/day MMF. Outcome measures were 24 h for proteinuria, serum creatinine, C3/C4 levels, and anti-dsDNA titers collected at the baseline and at 3-month treatment intervals. Daily urinary protein significantly decreased from 6.15 +/- 4.28 g to 2.69 +/- 2.36 g at the last visit (P < 0.01) in spite of the significant absence of changes in serum creatinine levels. The response rate was 65.7% including five (14.3%) cases of complete remission and 18 (51.4%) cases of partial remission. The concomitant oral prednisolone dose decreased significantly from 20.07 +/- 11.78 mg/day to 13.93 +/- 6.79 mg/day at 6 months (P < 0.01). The level of C3 increased significantly from 59.46 +/- 32.73 to 71.99 +/- 25.81 (P < 0.01) and the anti-dsDNA antibody titer decreased from 161.71 +/- 221.42 to 46.57 +/- 117.47 (P < 0.01). No severe adverse effects were observed in the study. Low-dose MMF (0.5 to 1 g/day) combined with glucocorticoids appears to be a safe and effective therapy for lupus nephritis in Taiwanese patients. Our results suggest that lupus nephritis in Oriental patients might respond to lower doses of MMF than Caucasians.
霉酚酸酯（MMF）最近被引入作为治疗系统性红斑狼疮（SLE）伴肾小球肾炎的免疫抑制剂，且数据令人鼓舞。然而，对 MMF 治疗的反应似乎存在种族差异。因此，我们确定了低剂量 MMF 治疗台湾狼疮肾炎患者的疗效和安全性。我们研究了 36 例接受 MMF 治疗的狼疮肾炎患者。起始剂量为 0.5g/天，收集了接受最高 1g/天 MMF 治疗的患者的数据。疗效指标为治疗前和 3 个月治疗间隔时的 24 小时蛋白尿、血清肌酐、C3/C4 水平和抗 dsDNA 滴度。尽管血清肌酐水平无显著变化，但每日尿蛋白显著从 6.15+/-4.28g 降至最后一次就诊时的 2.69+/-2.36g（P<0.01）。缓解率为 65.7%，包括完全缓解 5 例（14.3%）和部分缓解 18 例（51.4%）。同时口服泼尼松剂量从 20.07+/-11.78mg/天显著降至 6 个月时的 13.93+/-6.79mg/天（P<0.01）。C3 水平显著从 59.46+/-32.73升至 71.99+/-25.81（P<0.01），抗 dsDNA 抗体滴度从 161.71+/-221.42降至 46.57+/-117.47（P<0.01）。研究中未观察到严重不良反应。低剂量 MMF（0.5-1g/天）联合糖皮质激素似乎是台湾狼疮肾炎患者安全有效的治疗方法。我们的结果表明，东方患者的狼疮肾炎可能对 MMF 的剂量要求低于白人。
