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Abstract: FR-PO1110

Mycophenolate Mofetil in Lupus Nephritis: Long Term Efficacy and Safety Outcomes

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Beckwith, Hannah K.S., Imperial College Lupus Centre, London, United Kingdom
  • Cubillo, Beatriz Rodriguez, Imperial College Lupus Centre, London, United Kingdom
  • Pillay, Camilla, Imperial College Lupus Centre, London, United Kingdom
  • Griffith, Megan, Imperial College Lupus Centre, London, United Kingdom
  • Levy, Jeremy B., Imperial College Lupus Centre, London, United Kingdom
  • Cairns, Tom, Imperial College Lupus Centre, London, United Kingdom
  • Lightstone, Liz, Imperial College Lupus Centre, London, United Kingdom
Background

There is a lack of long-term (LT) efficacy and safety data for Mycophenolate mofetil (MMF) in the treatment of lupus nephritis (LN) [1]. We have used MMF since 1999 and undertook a retrospective case-note review of all patients whose treatment included MMF and at least 10 years follow-up (FU).

Methods

96 patients with biopsy-proven LN who started MMF ≥10 years ago were identified for the study.

Results

75 (78%) were female; 20 (21%) Black and 8 (8%) Asian. At diagnostic renal biopsy, median age was 35 years (IQR 26-45), serum creatinine (SCr) 90umol/l (IQR 73-140) and UPCR 318 mg/mmol (IQR 153-569). The median length of FU was 11.6 years (IQR 10.7-13.6). Median cumulative MMF exposure was 8.4 years (IQR 5.5-11.5).

17/96 (18%) reached ESRD (median 67 months, range 3-188) and 5/96 (5%) died during FU (median 124 months, IQR 86-129). The rates at 7 years FU (12/96 and 1/96) were not statistically different to those reported in the LT FU of the MAINTAIN trial (p= 0.55, p=0.08) [2]. Median duration of MMF was 5.4 years (IQR 2.0-7.2) in the patients who died.

At our unit, treatment regimens changed during the time period reviewed, moving to induction with MMF +/- Rituximab, mostly without oral steroids. We found no difference in adverse events between the Cyclophosphamide and MMF regimens, and patients did equally well on either regimen (Table 1). Importantly, no significant difference in adverse events was seen with MMF exposure ≥10 years vs <10 years (p=0.91) (IQR 11.2-13.6 vs 3.8-7.6).

Conclusion

This is the largest study to report LT outcomes in patients receiving MMF and the first to report data over ten years. LT treatment with MMF appears to be safe and our data supports the use of non-CyP based regimens. The increase in number of patients with ESRD or who died after 7 years FU emphasises the importance of LT follow up data in these cohorts.

References
[1] Bertsias GK et al. Ann Rheum Dis 2012;71:1771-1782
[2] Tamirou F et al. Ann Rheum Dis 2016;75:526–531