Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Mycophenolate Mofetil Dosing and Renal Relapse or Renal Endpoint in Lupus Nephritis
Farmer-Boatwright, Mary Katherine, Gibson, Keisha L., Hogan, Susan L., Hu, Yichun, Jennette, Caroline E., Dooley, Mary Anne
To examine the relationship between mycophenolate mofetil (MMF) dosing and renal endpoints in a SE US renal-biopsy based cohort. Endpoints included renal relapse, sustained doubling of creatinine, end-stage renal disease (ESRD) and death.
We performed a retrospective chart review of consented patients with proliferative or membranous nephritis from this registry. Data were examined using descriptive statistics and Wilcoxon two-sample test.
Sixty-two subjects with a median age of 28.5 years (range 8.460.7) were included. Baseline estimated GFR (eGFR) and eGFR at last follow up were similar (84.3+/- 40.4 cc/min; 83.7 (+/- 47.9) cc/min). Median follow up was 36 months (range 6114 months). The median maximum daily dose of MMF was 2000 mg (range 7503000 mg). Seven patients (11%) reached a renal endpoint. They had an average daily maximum dose of 1607 mg MMF (+/- 453 mg), compared to those with no renal endpoint (2273 +/- 632 mg [p = 0.013]). We characterized 33 relapses in 25 patients at an average of 20.3 months (+/- 10.9) into treatment. The average maximum daily dose of MMF among relapsers was 2096 mg (+/- 637 mg) compared to 2400 mg (+/- 548 mg) in non-relapsers (p = 0.069). The average MMF dose at the time of first relapse was 1481 mg (+/- 790 mg), versus non-relapsers at 2400 mg (+/- 548 mg; p<0.0001). Two deaths occurred, both in patients who were non-relapsers: one due to CNS lymphoma, and the other to non-accidental trauma.
Our results suggest that lower doses of MMF are associated with renal relapse, doubling of serum creatinine, ESRD or death. Further studies are necessary to define the interaction between patient factors and dosing.
To cite this abstract, please use the following information:
Farmer-Boatwright, Mary Katherine, Gibson, Keisha L., Hogan, Susan L., Hu, Yichun, Jennette, Caroline E., Dooley, Mary Anne; Mycophenolate Mofetil Dosing and Renal Relapse or Renal Endpoint in Lupus Nephritis [abstract]. Arthritis Rheum 2009;60 Suppl 10 :268