Pediatric Rheumatology Online Journal → July 2003 → Childhood Lupus→ Treatment → Abstract #103

MYCOPHENOLATE MOFETIL (CELLECEPT) IN CHILDREN WITH LUPUS NEPHRITIS

S. K. F. Oliveira

¹Pediatric Rheumatology, IPPMG - Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil

Background: Treatment of severe lupus nephritis is still a problem. The experience with mycophenolate mophetil (MMF) is scarce and there is little data on this drug in cases that are resistant or flare after the end of treatment with intravenous cyclophosphamide. As in children there is no report on this drug in cases of lupus nephritis, we decided to report our experience.
Patients and Methods: Five SLE patients (1982 ACR revised criteria) with disease onset [le> 18 yrs of age and regularly followed at our clinic were selected in a prospective study. All of them had been on cyclophosphamide pulses previously and the indication for MMF treatment was based on an insufficient response in 2, intolerance due to side effects in 1 and flare during the treatment in 2. All patients had only renal disease activity at the beginning of the treatment and therefore only renal parameters of evaluation were used. Steroid doses were considered during the follow-up.
Results: There was one male and 4 female patients. Average age at the beginning of JSLE was 12y 8mo (9y 8mo a 17y). WHO classification of lupus nephritis was diffuse GN in 2, membranous GN in 2 and focal-segmental GN in 1. Duration of the lupus disease when MMF was introduced was 53 months (22 to 108 months). Dosage of MMF changed from 1 to 2 grams per day during 6 to 23 months of follow-up. During the treatment, anti-DNA became negative in 3 out of 4 patients and was significantly reduced in the fourth. Normalization of C3 was observed in 3 out of 4 and of C4 in 3 out of 3. Proteinuria was reduced in 3 out of 4. Normalization of hematuria was observed in 2 out of 2 and creatinine cleareance didn't change. Steroids could be reduced in 3 and kept in low doses in 2. No patient presented side effects.
Conclusion: We concluded that MMF is a well tolerated drug and is a valid option of treatment in children with lupus nephritis that flares after the end of cyclophosphamide pulsetherapy or in the cases which have become intolerant to it.