Background/Purpose: Mycophenolate mofetil (MMF), along with corticosteroids, is considered as the standard of care in lupus nephritis (LN); however, its efficacy in extra-renal manifestations of systemic lupus erythematosus (SLE) is less well known. This study aimed to determine its effectiveness in non-renal lupus.

Methods: One hundred seventy seven SLE patients (diagnosis according to the 1997 ACR criteria or 3 criteria and a compatible renal biopsy) were enrolled; 105 for whom MMF was introduced for active LN (age 35.6±10.7 years, disease duration 8.9±7.8 years) and 72 for extra-renal manifestations (age 38.6±11.7 years, disease duration 11.7±9.2 years). The main indication for MMF initiation was based on the respective SLE Disease Activity Index (SLEDAI-2K) element that was present at that time. Patients were subdivided according to the major non-renal manifestation (central nervous system involvement, vasculitis, musculoskeletal features, skin disease, serositis, immunological and hematological abnormalities). Improvement was defined as the absence of the initial clinical or laboratory manifestation after 6 and 12 months. The statistical software SAS 9.3 was used for analysis; p<0.05 was considered significant.

Results: Cumulatively, the initial clinical manifestation or hematological abnormality was resolved in 42/72 non-renal patients (58.3%) after 6 months and in 45/72 (62.5%) after 12 months. Corticosteroid dose was reduced in 44/72 (61.1%, p<0.001) patients (mean dose 18.4±12.6mg/day at baseline to 12.1±9.0mg/day after 12 months, p<0.05). In renal patients, 40 (38.1%) had complete resolution of the extra-renal manifestation after 6 months, while 53 (50.5%) achieved complete response after 12 months. Prednisone dose was reduced in 73/105 patients (69.5%) after 12 months (mean dose 29.2±16.6mg/day at baseline to 15.3±9.7mg/day, p<0.001). Details on the improvement rates of the different clinical features are shown in the table.

CNS: central nervous system, VASC: vasculitis, MSK: musculoskeletal (arthritis, myositis), SERO: serositis, IMMUNO: immunological abnormalities (low C3/C4 and/or increased anti-DNA titers, HEMA: hematological abnormalities.

Conclusion: MMF is an efficacious therapeutic approach for the management of refractory non-renal manifestations of SLE in 6 and 12 months, leading to complete resolution of the initial clinical manifestation in more than half of the patients and significant reduction in corticosteroid dose.

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/mycophenolate-mofetil-in-non-renal-manifestations-of-systemic-lupus-erythematosus-an-observational-cohort-study/