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Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
Mycophenolate Mofetil In Relapsing Lupus Nephritis
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Mycophenolate Mofetil In Relapsing Lupus Nephritis

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MSN 2007 Abstract Presentation

MSN 2007 Abstract Presentation

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  • 1. MYCOPHENOLATE MOFETIL IN RELAPSING LUPUS NEPHRITIS Chow YW, Yahya R, Visvanathan R Department of Nephrology, Kuala Lumpur Hospital
  • 2. Introduction <ul><li>Induction therapy </li></ul><ul><li>Intensive immunosuppressives </li></ul><ul><li>Objectives : to halt injury, </li></ul><ul><li>: recover renal function </li></ul><ul><li>: induce remission by controlling immunologic activity </li></ul><ul><li>Maintenance therapy </li></ul><ul><li>Longer period </li></ul><ul><li>Less intensive to reduce complication </li></ul><ul><li>Objectives : Consolidate remission </li></ul><ul><li> : Prevent flares </li></ul>
  • 3. MYCOPHENOLATE MOFETIL IN LUPUS NEPHRITIS <ul><li>Induction </li></ul><ul><ul><li>Chan, NEJM 2000, 343 (16): 1156 </li></ul></ul><ul><ul><li>Ginzler E, Appel G, NEJM 2005(353:21):2219 </li></ul></ul><ul><ul><li>LM Ong, LS Hooi, Nephrology 2005(10) :504-510 </li></ul></ul><ul><li>Maintenance </li></ul><ul><ul><li>Contreras, NEJM 2004, 350(10): 971 </li></ul></ul><ul><ul><li>Chan et al, JASN 2005(16):1076-1084 </li></ul></ul>
  • 4. Relapse Rate with current standard care Median: 38 months 39 38 Standard CYC & pulse MP Cortes-Hernandez 2003 Varied treatment Low dose steroid with Azathioprine Pulse CYC, pulse MP or combination Corticosteroid & immunosupressive Treatment Within 18 months 59 91 Mosca 2002 Mean : 40 months to first flare 37 46 El Hachmi 2003 CR: median 36 mths PR: median 18 mths 45 92 Illei 2002 Within 103 months 51 211 Beji 2005 Duration % n Publications
  • 5. Objective <ul><li>Significant proportion of patients with lupus nephritis </li></ul><ul><ul><li>poor renal response to induction and maintenance pulse intravenous cyclophosphamide (CyP). </li></ul></ul><ul><li>This study reports our experience with Mycophenolate Mofetil (MMF) in treatment of relapsing lupus nephritis. </li></ul>
  • 6. Design & Methods <ul><li>Six patients </li></ul><ul><li>Mean age of 25.67 + 5.18 years </li></ul><ul><li>WHO Class IV </li></ul><ul><ul><li>4 patients </li></ul></ul><ul><li>WHO Class V </li></ul><ul><ul><li>2 patients </li></ul></ul><ul><li>Relapsing lupus nephritis </li></ul><ul><ul><li>Previously treated with </li></ul></ul><ul><ul><li>Intravenous CyP 0.75-1g/m2 </li></ul></ul><ul><ul><li>(12-21 doses with cumulative dose of 13.23 + 2.4g) </li></ul></ul><ul><ul><li>Azathioprine (2.07 + 0.16 mg/kg body weight) </li></ul></ul><ul><li>Treated with at least six months of MMF were included in the analysis </li></ul>
  • 7. Design & Methods <ul><li>24 hour Urine Protein, </li></ul><ul><li>Serum Albumin, </li></ul><ul><li>Serum Creatinine, </li></ul><ul><li>Estimated GFR (eGFR) </li></ul><ul><li>Serum cholesterol </li></ul><ul><ul><li>1, 3 and 6 months </li></ul></ul>
  • 8. Definitions <ul><li>Complete remission </li></ul><ul><li>Urinary protein excretion less than 0.3g/24hours and </li></ul><ul><li>Normal serum albumin (>30g/L) and </li></ul><ul><li>Improved or stable renal function </li></ul><ul><li>Partial remission </li></ul><ul><li>Urinary protein excretion reduced by > 50% with range of 0.3-3.0g/24hours and </li></ul><ul><li>Serum albumin > 30g/L </li></ul>
  • 9. Definitions <ul><li>Progressive renal impairment </li></ul><ul><li>Rise in serum creatinine > 50umol/l or </li></ul><ul><li>Decrease in creatinine clearance exceeding 15% of baseline </li></ul><ul><li>Treatment failure </li></ul><ul><li>Persistent urinary protein excretion > 3g/24hours or </li></ul><ul><ul><ul><li>Progressive renal impairment within 12 months of starting therapy </li></ul></ul></ul><ul><ul><ul><li>or </li></ul></ul></ul><ul><li>Permanent discontinuation of therapy as a result of drug side effects. </li></ul>
  • 10. Result 30 2.0 IV M 27 Pt 6 10 2.0 IV F 30 Pt 5 27 2.0 IV F 28 Pt 4 6 2.0 IV F 17 Pt 3 18 1.0 V F 24 Pt 2 22 2.0 V F 28 Pt 1 F/up (mth) MMF dose WHO Class Sex Age
  • 11. Result R 1.5 15.4 Skin, Jt Pt 6 R 1.5 14.6 Skin, Jt Pt 5 R 1.5 13.0 Skin, Jt Pt 4 R 2.0 13.4 Hemato, CNS Pt 3 R 2.4 12.0 CNS, Skin Pt 2 R 2.0 12.3 Hemato, Skin Pt 1 MMF Indi Aza (mg/kg) CYC (g) SLE Criteria
  • 12. Result PR Losartan 100mg dly -- Pt 6 CR -- Perindopril 8mg dly Pt 5 PR -- Perindopril 8mg dly Pt 4 NR -- Enalapril 10mg BD Pt 3 NR* Telmisartan 80mg dly Perindopril 8mg dly Pt 2 CR Losartan 100mg dly Perindopril 8mg dly Pt 1 Response ARB ACEI
  • 13. Result <ul><li>Mean dose of MMF </li></ul><ul><ul><li>1.83 + 0.41 g/d </li></ul></ul><ul><li>Mean duration of therapy </li></ul><ul><ul><li>14.17 + 7.39 months. </li></ul></ul><ul><li>Mean time to response </li></ul><ul><ul><li>6.00 + 1.58 months </li></ul></ul><ul><li>24 hour urine protein </li></ul><ul><ul><li>1.62 + 0.89 to 0.86 + 1.22g/24 hours </li></ul></ul><ul><li>Serum albumin </li></ul><ul><ul><li>23.00 + 5.13 to 31.17 + 10.89g/L </li></ul></ul>
  • 14. Result <ul><ul><li>Serum cholesterol </li></ul></ul><ul><ul><ul><li>7.87 + 3.61 to 5.65 + 2.00mmol/L </li></ul></ul></ul><ul><ul><li>Renal function </li></ul></ul><ul><ul><ul><li>92.67 + 40.14 to 84.17 + 14.28umol/L </li></ul></ul></ul><ul><ul><li>eGFR </li></ul></ul><ul><ul><ul><li>81.41 + 38.98 to 83.39 + 17.25mls/min/ 1.73m2 </li></ul></ul></ul><ul><ul><li>Serum complement component C3 </li></ul></ul><ul><ul><ul><li>0.35 + 0.19 to 0.64 + 0.49g/L </li></ul></ul></ul>
  • 15. Result: 24 hour urine protein 1.62 + 0.89 to 0.86 + 1.22g/24 hours
  • 16. Result- Serum albumin 23.00 + 5.13 to 31.17 + 10.89g/L
  • 17. Result- Serum cholesterol 7.87 + 3.61 to 5.65 + 2.00mmol/L
  • 18. Result- Renal function 92.67 + 40.14 to 84.17 + 14.28umol/L
  • 19. Results- eGFR 81.41 + 38.98 to 83.39 + 17.25mls/min/ 1.73m2
  • 20. Results - C3 0.35 + 0.19 to 0.64 + 0.49g/L
  • 21. Adverse Events <ul><li>2 patients had diarrhea </li></ul><ul><li>1 patient had nausea during initial MMF therapy which disappeared with time. </li></ul>
  • 22. Conclusion <ul><li>MMF is an effective therapy for relapsing lupus nephritis and is well tolerated. </li></ul>
  • 23. Discussion
  • 24. MYCOPHENOLATE MOFETIL IN LUPUS NEPHRITIS <ul><li>Induction </li></ul><ul><ul><li>Chan, NEJM 2000, 343 (16): 1156 </li></ul></ul><ul><ul><li>Ginzler E, Appel G, NEJM 2005(353:21):2219 </li></ul></ul><ul><ul><li>LM Ong, LS Hooi, Nephrology 2005(10) :504-510 </li></ul></ul><ul><li>Maintenance </li></ul><ul><ul><li>Contreras, NEJM 2004, 350(10): 971 </li></ul></ul><ul><ul><li>Chan et al, JASN 2005(16):1076-1084 </li></ul></ul>
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