J Rheum Dis 2019; 26(1): 57-65  
Comparison of Renal Responses to Cyclophosphamide and Mycophenolate Mofetil used as Induction Therapies in Korean Patients with Lupus Nephritis
Sung-Eun Choi1,*, Dong-Jin Park1,*, Ji-Hyoun Kang1, Kyung-Eun Lee1, Haimuzi Xu1, Ji Shin Lee2, Yoo-Duk Choi2,
Shin-Seok Lee1
1Division of Rheumatology, Department of Internal Medicine, and 2Department of Pathology, Chonnam National University Medical School & Hospital, Gwangju, Korea
Correspondence to: Shin-Seok Lee http://orcid.org/0000-0001-6810-7355 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea. E-mail:shinseok@chonnam.ac.kr
Received: September 13, 2018; Revised: November 12, 2018; Accepted: November 13, 2018; Published online: January 1, 2019.
© Korean College of Rheumatology. All rights reserved.

This is a open Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective. Although intravenous cyclophosphamide (IVC) is generally accepted as the standard therapy for induction treatment of active proliferative lupus nephritis (LN), several clinical trials have suggested that mycophenolate mofetil (MMF) is at least as effective as IVC. Because few Asian studies have compared the two treatment modalities, we compared the efficacies of MMF and IVC as LN remission induction treatments in Korean patients. Methods. We enrolled 39 patients with class III and IV LN who received MMF or IVC as LN induction therapy. The renal outcomes (i.e., complete response [CR], partial response [PR], and no response [NR]) at 6 and 12 months were defined using the ACR 2006 response criteria. Results. Of 39 patients, 23 (59.0%) were treated with IVC, and 16 (41.0%) were treated with MMF. Demographics, clinical characteristics, laboratory data, and adverse events did not significantly differ between the two groups. However, C3 levels were lower and activity scores in renal biopsy were higher in IVC-treated patients. CRs were achieved by 11 (47.8%) of the patients receiving IVC and 7 (43.8%) of the patients receiving MMF after 6 months of treatment (p=0.961) and by 11 (47.8%) of those who received IVC and 9 (56.2%) of those who received MMF at 12 months of treatment (p=0.713). Neither the PR rate nor the NR rate differed significantly at 6 or 12 months between the two groups. Conclusion. The efficacy of MMF does not differ from that of IVC in terms of induction of LN remission in Korean patients.
Keywords: Lupus nephritis, Cyclophosphamide, Mycophenolic acid, Induction of remission


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