Comparison of mycophenolic acid with cyclophosphamide for the treatment of pediatric lupus nephritis: A retrospective study from a tertiary center hospital in Taiwan

Huei-Geng Chen; Jin-Shuen Chen; Yao-Shen Chen; Chun-Hao Yin; Hsiao-Ching Chen; Yee-Hsuan Chiou

doi:10.1016/j.jmii.2023.08.003

Comparison of mycophenolic acid with cyclophosphamide for the treatment of pediatric lupus nephritis: A retrospective study from a tertiary center hospital in Taiwan

J Microbiol Immunol Infect. 2023 Oct;56(5):1105-1113. doi: 10.1016/j.jmii.2023.08.003. Epub 2023 Aug 9.

Authors

Huei-Geng Chen¹, Jin-Shuen Chen², Yao-Shen Chen², Chun-Hao Yin³, Hsiao-Ching Chen⁴, Yee-Hsuan Chiou⁵

Affiliations

¹ Division of Pediatric Allergy Immunology and Rheumatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Pediatrics, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan.
² Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
³ Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Institute of Health Care Management, National Sun Yat-sen University, Taiwan.
⁴ Division of Pediatric Allergy Immunology and Rheumatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
⁵ Division of Pediatric Allergy Immunology and Rheumatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Division of Pediatric Nephrology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Medical Laboratory Science and Biotechnology, Fooyin University, Kaohsiung, Taiwan. Electronic address: chysn@ms6.hinet.net.

PMID: 37586916
DOI: 10.1016/j.jmii.2023.08.003

Abstract

Background: This study aimed to compare the efficacy of mycophenolic acid (MPA) and cyclophosphamide (CYC) for treating pediatric lupus nephritis (pLN).

Methods: Data on patients with pLN class III, IV, and V, diagnosed by renal biopsy, were collected from the Databank of Kaohsiung Veterans General Hospital between February 2005 and December 2020. The study included 31 pLN patients. Of these, 15 received MPA (MPA group) and 16 received CYC (CYC group). Systemic lupus erythematosus disease activity index score, laboratory findings, complete remission (CR), and partial remission (PR) were assessed at 6, 12, and 24 months.

Results: In the MPA group, CR occurred in 7/15 (47%) patients at month 6 and in 11/15 (73%) at months 12 and 24. In the CYC group, CR was reached in 5/16 (31%) patients at month 6, in 8/16 (50%) at month 12, and in 9/16 (56%) at month 24. PR was seen in 3/15 (20%) patients in the MPA group and in 3/16 (19%) in the CYC group at month 24. The cumulative probability of CR and PR showed no statistically significant difference between the two groups. However, the estimated glomerular filtration rate (eGFR) improved significantly in the MPA group at months 6, 12 and 24 compared to that in the CYC group (p < 0.05).

Conclusion: The efficacy of MPA is similar to that of CYC for pLN treatment, with MPA providing a significant improvement in eGFR after pLN induction therapy at months 6,12 and 24.

Keywords: Cyclophosphamide; Lupus nephritis; Mycophenolic acid; Pediatric.