Outcomes of multitarget therapy using mycophenolate mofetil and tacrolimus for refractory or relapsing lupus nephritis

Lupus ◽  
2018 ◽  
Vol 27 (6) ◽  
pp. 1007-1011 ◽  
Author(s):  
C-B Choi ◽  
S Won ◽  
S-C Bae
Keyword(s):  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Multitarget Therapy

scholarly journals Effect of a multitarget therapy with prednisolone, mycophenolate mofetil, and tacrolimus in a patient with type B insulin resistance syndrome complicated by lupus nephritis

2021 ◽  
Author(s):  
Jumpei Temmoku ◽  
Tomoyuki Asano ◽  
Kenji Saito ◽  
Haruki Matsumoto ◽  
Yuya Fujita ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Severe Hypoglycaemia ◽  
Insulin Receptors ◽  
Insulin Resistance Syndrome ◽  
Type B ◽  
Old Japanese ◽  
Multitarget Therapy

ABSTRACT Type B insulin resistance syndrome (TBIR) is a rare autoimmune disease characterised by autoantibodies targeting insulin receptors. TBIR is often complicated by systemic lupus erythematosus (SLE). We describe the case of a 59-year-old Japanese man with TBIR complicated with lupus nephritis (LN), who presented with nephrotic syndrome and severe hypoglycaemia. Treatment with prednisolone (PSL), mycophenolate mofetil (MMF), and tacrolimus (TAC) resulted in improved SLE activity and glucose intolerance with the reduction of anti-insulin receptor autoantibodies. To the best of our knowledge, this is the first reported case of TBIR complicated with LN that was successfully treated using multitarget therapy with PSL, MMF, and TAC.

scholarly journals The Evolving Role of Calcineurin Inhibitors in Treating Lupus Nephritis

2020 ◽  
Vol 15 (7) ◽  
pp. 1066-1072
Author(s):  
Yonatan Peleg ◽  
Andrew S. Bomback ◽  
Jai Radhakrishnan
Keyword(s):  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Cell Function ◽  
Calcineurin Inhibitors ◽  
Protocol Biopsies ◽  
Attractive Option ◽  
Pregnancy And Lactation ◽  
Multitarget Therapy

The overall kidney survival among lupus nephritis patients has improved with currently used induction immunosuppression regimens of corticosteroids and either cyclophosphamide or mycophenolate mofetil; however, there still remains a significant number of lupus nephritis patients who do not achieve remission with these regimens. Investigators have looked at other immunosuppressive regimens for lupus nephritis, and there has been interest in the use of calcineurin inhibitors in this regard. Calcineurin inhibitors are potentially an attractive option because of their established ability to inhibit T cell function, attenuate proteinuria through non-immunologic means, and their safety in pregnancy and lactation. In this review, we discuss the findings and limitations of selected trials that evaluated the use of calcineurin inhibitors in the treatment of lupus nephritis, either with corticosteroids alone or as a component of multitarget therapy when combined with mycophenolate mofetil. There may be a role for calcineurin inhibitors among patients with heavy proteinuria, as well as younger patients with refractory lupus nephritis. The multitarget therapy trials reveal higher rates of remission compared with mycophenolate mofetil alone and cyclophosphamide; however, some trials highlight the possibility of more infectious adverse events. We discuss the need for further study of calcineurin inhibitors in more diverse patient populations and the need for trials with longer follow-up with “hard” endpoints beyond proteinuria reduction, such as worsening CKD or repeat protocol biopsies, given the calcineurin inhibitors ability to reduce proteinuria non-immunologically and thus increased rate of relapse when the drug is tapered. While there may indeed be a space for calcineurin inhibitors to help increase remission rates in lupus nephritis patients, more work is needed to help address the questions the studies available to date have yet to answer.

scholarly journals Efficacy of High-Dose Mycophenolate Mofetil in Multitarget Therapy for Lupus Nephritis: Two Consecutive Case Reports

Cureus ◽  
2020 ◽  
Author(s):  
Yoshitaka Furuto ◽  
Mariko Kawamura ◽  
Akio Namikawa ◽  
Hiroko Takahashi ◽  
Yuko Shibuya
Keyword(s):  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Case Reports ◽  
High Dose ◽  
Consecutive Case ◽  
Multitarget Therapy

scholarly journals SAT0177 MULTITARGET THERAPY WITH TACROLIMUS AND MYCOPHENOLATE MOFETIL FOR TREATMENT OF LUPUS NEPHRITIS PRESENTED WITH RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1030.1-1030
Author(s):  
Y. Imai ◽  
H. Ikeuchi ◽  
J. Suwa ◽  
Y. Ohishi ◽  
M. Watanabe ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Induction Therapy ◽  
Rapidly Progressive Glomerulonephritis ◽  
Induction Treatment ◽  
Research Support ◽  
Chugai Pharmaceutical ◽  
Short Period ◽  
Multitarget Therapy ◽  
Class Iv

Background:Although, most lupus nephritis patients present with chronic glomerulonephritis or nephrotic syndrome, some patients develop rapidly progressive glomerulonephritis (RPGN), which is a clinical syndrome characterized by rapid loss of renal function over a short period of time (days to months). Multitarget therapy using tacrolimus and mycophenolate mofetil (MMF) has been reported to be effective as induction therapy of Class III to Class V lupus nephritis1. However, its efficacy on lupus nephritis presented with RPGN has not been well reported.Objectives:We aimed to examine the efficacy of multitarget therapy on lupus nephritis presented with RPGN.Methods:We retrospectively analyzed patients with biopsy-proven lupus nephritis, who clinically showed RPGN, and were treated by multitarget therapy with tacrolimus and MMF in our department. Data were expressed as mean±SD.Results:Five lupus nephritis patients (3 female) with RPGN were treated by multitarget therapy as induction therapy. Mean age was 36.6±13.5 years old. Renal biopsy at treatment revealed Class IV(A) in 2, Class IV(A+C) in 1 and Class IV(A)+V in 2. The percentage of glomerular crescents was 23.1±25.4%. eGFR and proteinuria at the initiation of treatment were 46.8±11.5 mL/min/1.73m2and 7.7±3.4 g/gCr, respectively. Patients were initially treated with methylprednisolone pulse therapy followed by 0.8-1.0 mg/kg of prednisolone (PSL), 2-3 mg/day of tacrolimus and 1000 mg/day of MMF. At 6 months, eGFR and proteinuria improved to 72.9±11.3 mL/min/1.73m2and 0.19±0.13 g/gCr, respectively. At 12 months, eGFR and proteinuria further improved to 76.8±7.8 mL/min/1.73m2and 0.10±0.07 g/gCr, respectively and the dose of PSL was reduced to 6.6±1.5 mg/day. Three patients became positive for cytomegalovirus antigenemia and were successfully treated with antiviral therapy.Conclusion:Multitarget therapy is effective in lupus nephritis even in patients presented with RPGN.References:[1]Liu Z, Zhang H, Liu Z,et al. Multitarget therapy for induction treatment of lupus nephritis: a randomized trial.Ann Int Med2015; 162: 18-26.Disclosure of Interests:Yoichi Imai: None declared, Hidekazu Ikeuchi Speakers bureau: CHUGAI PHARMACEUTICAL CO., LTD.Astellas Pharma Inc., Junya Suwa: None declared, Yuko Ohishi: None declared, Mitsuharu Watanabe: None declared, Masao Nakasatomi: None declared, Hiroko Hamatani: None declared, Toru Sakairi: None declared, Yoriaki Kaneko Grant/research support from: CHUGAI PHARMACEUTICAL CO., LTD.Astellas Pharma Inc. b, Speakers bureau: CHUGAI PHARMACEUTICAL CO., LTD.Astellas Pharma Inc., Keiju Hiromura Grant/research support from: CHUGAI PHARMACEUTICAL CO., LTD.Astellas Pharma Inc., Speakers bureau: CHUGAI PHARMACEUTICAL CO., LTD.Astellas Pharma Inc.

Fetal proximal and distal limb anomalies following exposure to mycophenolate mofetil during pregnancy: A case report and review of the literature

Lupus ◽  
2021 ◽  
pp. 096120332110214
Author(s):  
Hoda MM Abdulaziz ◽  
Rasha Samir Shemies ◽  
Mohamed Taman ◽  
Alaa Mosbah ◽  
Ghada Elkannishy
Keyword(s):  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Intrauterine Growth Restriction ◽  
Unplanned Pregnancy ◽  
Wide Spectrum ◽  
Contraceptive Methods ◽  
Teratogenic Effects ◽  
Intrauterine Growth ◽  
Effective Contraceptive

Background Mycophenolate mofetil (MMF) is currently used in a wide spectrum of autoimmune diseases and has been rendered very effective in the management of systemic lupus erythematosus and lupus nephritis. MMF is known to be teratogenic (FDA category D) and therefore, women in childbearing period receiving MMF should be counselled to use effective contraceptive methods to avoid an unplanned pregnancy. Case A 22-year-old lady accidentally discovered to be pregnant while using MMF as a treatment of lupus nephritis which was replaced later on by azathioprine. After maternal and fetal evaluation, maternal lupus flare was confirmed and multiple fetal skeletal deformities associated with intrauterine growth restriction (IUGR) were diagnosed by 4-dimensional ultrasound. Termination of pregnancy was decided after shared decision making. Conclusion Women in childbearing period should be advised to postpone pregnancy for at least six weeks after stoppage of MMF therapy because of its potential teratogenic effects during pregnancy.

Mycophenolate Mofetil for Remission Induction in Severe Lupus Nephritis

2005 ◽  
Vol 100 (3) ◽  
pp. c92-c100 ◽  
Author(s):  
Jane Cross ◽  
Adu Dwomoa ◽  
Peter Andrews ◽  
Aine Burns ◽  
Caroline Gordon ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Remission Induction ◽  
Severe Lupus Nephritis
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