Cyclosporine & Mycophenolate Mofetil in the Treatment of Cyclophosphamide Refractory Class-IV Lupus Nephritis

Class IV Lupus Nephritis is a difficult medical situation requiring aggressive management. Many patients do not respond to conventional cyclophosphamide (CPM) therapy. The aim of this study was to evaluate the effect of cyclosporine (CsA) and mycophenolate mofetil (MMF) in the treatment of CPM refractory class IV Lupus nephritis. The study was conducted at Combined Military Hospital (CMH) and Cantonment General Hospital (CGH) of Dhaka over a period of 8 years (from January 2000 till December 2008). CPM refractory Class IV Lupus nephritis patients were randomly assigned into 2 groups cyclosporine (4mg/kg/day) and mycophenolate mofetil (1000-2000mg/day). Thirty one patients completed at least one year follow up and were included in the study. Sixteen patients were included in cyclosporine group and 15 patients in mycophenolate mofetil group. CsA treated patients had a remission rate of 87.5% which was 80% in MMF group. The average remission time was 16.21 weeks in CsA and 20.91 weeks in MMF group. The urinary total protein(UTP) and creatinine clearance (CCr) values were similar in both groups, 0.54 gm vs 0.66 gm & 81 vs 86 ml/min. The systemic lupus erythematosus disease activity index (SLEDAI) was 9.56 and 9.2 in CsA and MMF group which came down to 1.92 and 1.83 in the same groups after remission. In this study It was found that both cyclosporine and mycophenolate mofetil were very effective in the treatment of CPM refractory class IV Lupus nephritis with slight better response with cyclosporine. Key words: Lupus Nephritis, mycophenolate mofetil, cyclosporine. DOI: 10.3329/jafmc.v5i2.4575 JAFMC Bangladesh Vol.5(2) (December) 2009, pp.8-13