A recent study, published in the journal Medicine, has found that Mycopheenolate mofetil (MMF) could be a more advantageous therapy for lupus nephritis than cyclophosphamide (CYC) when it comes to improving serum complement C3 and reaching complete remission. The study also found that MMF had fewer AEs compared to CYC.
The Study
The goal of this study was to determine whether MMF or CYC is a better induction therapy (in terms of efficacy and safety) for lupus nephritis.
Researchers conducted a meta analysis by searching various library databases and collecting data on randomized and controlled clinical trials of lupus nephritis patients taking CYC, MMF, or a combination of one of these therapies with another drug. In total, data was collected from 18 articles and 1989 patients. The primary endpoint of this trial was the response to serum creatinine, serum complement C3, and urine protein. Secondary endpoints were complete remission as well as adverse reactions.
5 of the studies examined had investigated change in serum complement C3. These studies indicated that MMF was a better therapy than CYC for increasing the levels of this complement. Additionally, MMF was more likely to result in complete remission.
7 of the trials studied investigated how the therapies vary in improvements of serum creatine. These studies found that neither MMF or CYC was found to have a significantly different effect.
Notably, this meta analysis found that Asian patients may benefit more from CYC than MMF. The same is true for those who have low (less than 4 grams per day) baseline urine protein levels. However, these groups are the exceptions. For the vast majority of patients, MMF was found to be more beneficial.
For the majority of patients taking MMF instead of CYC, the risk of infection was lower. For Asian patients specifically, this therapy was able to reduce the incidence of developing menstrual abnormalities or leukopenia.
Finally, CYC was found to produce more gastrointestinal symptoms than MMF in patients. This finding held across all races in the trials.
You can read more about this meta analysis and these two therapies here.
