Session Type: Abstract Submissions (ACR)
Background/Purpose: Mycophenolate mofetil (MMF) is frequently used for the treatment of lupus. The immune-modulating effects of MMF extend beyond effects on lymphocyte proliferation, and include inhibition of adhesion molecule expression, suppression of NO production, and reduction in cardiovascular morbidity and progression of atherosclerosis in cardiac and renal transplant patients.We examined the association between cardiovascular and non-cardiovascular damage among patients taking MMF, mycophenolic acid (MPA), AZA or methotrexate (MTX) in lupus centers participating in a North American patient registry of the Lupus Clinical Trials Consortium, Inc. (LCTC).We hypothesized that the use of MMF or MPA is protective against both overall and cardiovascular damage in patients with lupus, compared to azathioprine (AZA).
Methods: The LCTC registry consists of consecutively enrolled adults with SLE from 16 North American centers, each contributing approximately 100 patients. Patients who were taking MMF or MPA, AZA, or MTX at the time of enrollment into the registry were included in the current analysis. Patients taking MMF/MPA and AZA were compared as were patients taking MTX vs. AZA with respect to: a.) the prevalence of any damage on American College of Rheumatology/SLICC Damage Index at baseline (ACR/SDI), defined as SDI ≥1, and b.) the prevalence of cardiovascular damage at baseline, defined as myocardial infarction, angina/coronary artery bypass graft, claudication, and/or stroke on ACR/SDI. Patients were excluded from the analysis if they were taking more than one DMARD.
Among 1507 patients enrolled, 430 patients were taking MMF or MPA, 183 were taking AZA, and 79 were taking MTX at baseline. Among treated patients, mean age was 48.1 ±13.5 in MTX group, 38.9 ±12.4 in the MMF group, and 39.4 ± 13.2 in the AZA group. A baseline history of renal disease was present in 10.1% of MTX subjects, 66.7% of MMF/MPA subjects, and 43.7% of AZA patients.
Any cardiovascular damage on the baseline SDI was seen in 9.2% of subjects. Any baseline damage on SDI (exclusive of cardiovascular damage) was present in 54.6% of subjects. The prevalence ratio (PR) for baseline cardiovascular damage present on the ACR/SDI in the MMF vs. AZA group was 0.83 (95% confidence interval [CI] 0.45 – 1.5, p=ns), while the PR for MTX vs. AZA was 1.17 (95% CI 0.5 – 2.7, p=ns). The PR for the presence of ANY non-cardiovascular damage on ACR/SDI at baseline for MMF/MPA vs. AZA was 0.96 (95% CI 0.75 – 1.2, p=ns), while the PR for MTX vs. AZA was 0.94 (95% CI 0.65 – 1.4, p=ns).
In this cross-sectional analysis, there was no difference in the baseline prevalence of either cardiovascular or total damage on SDI based on the use of MMF/MPA or MTX in comparison to AZA. Limitations of this study include the cross-sectional nature of the data, lack of information regarding the length of time of exposure to the medications of interest prior to study entry, and confounding by medication indication (e.g., nephritis).
Acknowledgement: The authors thank and acknowledge the Lupus Clinical Trials Consortium, Inc. (LCTC). The views expressed in this report are those of the authors and LCTC is not responsible for its specific content.
M. A. McMahon,
J. E. Craft,
G. S. Gilkeson,
K. C. Kalunian,
Genentech and Biogen IDEC Inc.,
Eli Lilly and Company,
R. J. Looney,
G. McGwin Jr.,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mycophenolate-mofetil-is-not-associated-with-reduced-cardiovascular-or-lupus-damage-accumulation-in-a-cross-sectional-lupus-cohort-study/