Background/Purpose: Mycophenolate Mofetil (MMF) has been long used in the treatment of systemic lupus Erythematosus (SLE). Despite its proven effectiveness, particularly in the treatment of lupus nephritis, further studies are warranted to investigate its role in long-term maintenance therapy. The purpose of this study was to describe our 20 years of practice experience using MMF with regards to its indications, safety, tolerability and treatment efficacy. Among patients on long-term maintenance therapy, we sought to identify rates of renal flare and of progression to end-stage renal disease (ESRD).

Methods: In this retrospective chart review, we identified all patients with SLE who were treated with MMF between 1999 and 2019. We recorded data about indications, duration of treatment, reason for discontinuation, and side effects. Treatment efficacy for lupus nephritis was evaluated by occurrence of remission, occurrence of renal flare, and of progression to ESRD.

Results: Six hundred and sixty patients with SLE were evaluated; among them, 101 were treated with MMF. The indications for starting MMF were lupus nephritis (89%), interstitial lung disease (7%), and use as a steroid-sparing agent (4%). The mean duration of treatment was 69 months. Treatment was discontinued due to inefficacy in 9% of patients, and due to side effects in 8% of patients. The most common side effects were Leukopenia (9%), nausea (7%) and diarrhea (6%). Among patients with lupus nephritis, 60% achieved complete remission and 16% achieved partial remission at 1-year follow-up. Of those who did not achieve remission after one year, 7/14 (50%) did by second year. Among the 25 patients treated for at least 5 years, 1 developed a flare between the 5 and 10-year follow-up period. Among the 15 patients treated for at least 10 years, no patients developed any flare at subsequent follow-up. Among patients on maintenance therapy, 3 progressed to ESRD.

Conclusion: Maintenance treatment with MMF constitutes an effective long-term treatment for lupus nephritis. Our practice demonstrates its tolerability over many years with few adverse effects, prevention of renal flares, and a low progression rate to ESRD.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mycophenolate-mofetil-for-systemic-lupus-erythematosus-our-20-year-experience/