Investigation on the benefits of mycophenolate mofetil and therapeutic drug monitoring in the treatment of Japanese patients with lupus nephritis

Takayuki Katsuno, Takenori Ozaki, Takaya Ozeki, Asaka Hachiya, Hangsoo Kim, Noritoshi Kato, Takuji Ishimoto, Sawako Kato, Tomoki Kosugi, Naotake Tsuboi, Masashi Mizuno, Yasuhiko Ito, Shoichi Maruyama

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)

Abstract

Background: Mycophenolate mofetil (MMF) is recommended as a first-line immunosuppressant to treat lupus nephritis (LN). Prognosis and therapeutic response in LN are known to vary depending on race. We investigated the benefits of MMF and therapeutic drug monitoring (TDM) in the treatment of Japanese LN patients. Methods: In this retrospective cohort study, a total of 20 patients with LN who started MMF treatment were included. Clinical data were collected regularly after MMF administration. We evaluated complete remission (CR) rate as the primary outcome. Predictors of CR were identified using univariate and multivariate analyses. In the research of TDM, the correlation with the area under the curve (AUC) was analyzed at MMF dose, single-point value, treatment response, and adverse events. Results: Overall, 70% of cases showed CR; both flare-ups and refractory cases had favorable results. Cases of LN with nephrotic syndrome (NS) or class III/IV + V showed a significantly lower CR rate (p < 0.005). The ratio of maintaining CR after MMF therapy was as high as 85.7%. In multivariate analysis, NS was an independent negative predictor of CR (HR 0.09, 95% confidence interval 0.01–0.81; p = 0.03). The relationship between AUC and MMF dose was low, and AUC correlated with trough level (r = 0.73). AUC tended to be high in the treatment responder (p = 0.09), but did not correlate with adverse events of infection (p = 0.92). Conclusion: MMF is a beneficial treatment option for Japanese LN patients, and further investigation on TDM-based therapy is needed.

Original languageEnglish
Pages (from-to)1341-1350
Number of pages10
JournalClinical and Experimental Nephrology
Volume22
Issue number6
DOIs
Publication statusPublished - 01-12-2018
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Physiology
  • Nephrology
  • Physiology (medical)

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