Outcome and predictors of renal survival in patients with lupus nephritis: Comparison between cyclophosphamide and mycophenolate mofetil

Abstract

Aim: To compare renal outcomes between cyclophosphamide (CYC) and mycophenolate mofetil (MMF), and attempt to identify a predictor of renal survival.

Methods: A total of 99 patients with class III-V lupus nephritis (LN) and treated with CYC or MMF were enrolled. The remission rate and predictors of poor renal outcomes in LN were assessed.

Results: The mean age at LN diagnosis was 31.7 years. The baseline characteristics of the two groups were similar except for the chronicity index (3.1 ± 2.4 and 2.3 ± 0.8 for CYC and MMF, respectively, P = 0.007). The overall remission rate was 76.8% and 77.7% after 6 and 12 months, respectively, with no significant difference between the two groups at these time points. After a median follow-up of 36 months (interquartile range 12-60), eight (8.1%) patients had chronic kidney disease, four (4.1%) were dialyzed permanently, and seven (7.1%) suffered a relapse, with no significant difference in these final outcomes between the two groups. Adverse events included infection (CYC group), and rash and neutropenia (MMF group), with no significant difference in frequency between the two groups. Failure of induction therapy (hazards ratio [HR] = 10.626, P = 0.022) and the creatinine level at diagnosis of LN (HR = 8.397, P = 0.007) were significantly associated with renal survival adjusted for age at LN diagnosis, disease duration and proteinuria.

Conclusion: Response to current induction therapy for LN was favorable, and 6 months response following induction therapy was the most important predictor for renal survival.

Keywords: cyclophosphamide; lupus nephritis; mycophenolate mofetil; outcome.