Glomerulonephritis 2010: Comparing New Therapeutics To Old
Glomerulonephritis 2010: Comparing New Therapeutics To Old
Glomerulonephritis 2010: Comparing New Therapeutics To Old
www.medscape.com
6/23/13
difference in the lik elihood of partial or complete remission among patients receiving mycophenolate mofetil as compared to cyclophosphamide (RR = 0.89; 95% CI, 0.711.10). Although there were also no differences between arms with respect to many safety parameters, there was a lower incidence of alopecia and amenorrhea among those receiving mycophenolate mofetil. Houssiau and colleagues [8] randomly assigned 105 patients with lupus nephritis who had achieved remission to either azathioprine or mycophenolate mofetil. All patients received 6 pulses of cyclophosphamide and glucocorticoids. Over a 3-year period, renal function and proteinuria was similar between the 2 groups. Renal flairs were seen in 25% of the azathioprine group and 19% of the mycophenolate mofetil group. Adverse events were similar between groups, but hematologic complications were slightly more frequent in the group receiving azathioprine (P = .03).
Summary
In 2010, trials in glomerulonephritis continued to try to define how newer immunosuppressives might complement more standard therapies for ANCA-associated glomerulonephritis and lupus nephritis. Although these newer agents provided similar outcomes in all except 1 trial,[2] notably their safety profiles were similar or, in some cases, better. Limitations included low power due to small sample size. However, this problem is found across most trials in glomerulonephritis given the uncommon incidence. Regardless, these trials clearly show a place for newer, easier-to-use agents in our armamentarium to treat inflammatory glomerular disease.
References
1. Jones RB, Tervaert JW, Hauser T et al; Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis. European Vasculitis Study Group. N Engl J Med. 2010 15;363:211-220. Abstract 2. Hiemstra TF, Walsh M, Mahr A, et al; European Vasculitis Study Group (EUVAS).Mycophenolate mofetil vs azathioprine for remission maintenance in antineutrophil cytoplasmic antibody-associated vasculitis: a randomized controlled trial. JAMA. 2010;304:2381-2388. Epub 2010 Nov 8. 3. Touma Z, Gladman DD, Urowitz MB, Beyene J, Uleryk EM, Shah PS. Mycophenolate mofetil for induction treatment of lupus nephritis: A systematic review and metaanalysis. J Rheumatol. 2010 Oct 15. [Epub ahead of print] 4. Ginzler EM, Dooley MA, Aranow C, et al. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Engl J Med. 2005; 353:2219-2228. Abstract 5. Chan TM, Tse KC, Tang CS, Mok MY, Li FK; Hong Kong Nephrology Study Group. Long-term study of mycophenolate mofetil as continuous induction and maintenance treatment for diffuse proliferative lupus nephritis. J Am Soc Nephrol. 2005;16:1076-1084. Epub 2005 Feb 23. 6. Appel GB, Contreras G, Dooley MA, et al. Aspreva Lupus Management Study Group. Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis. J Am Soc Nephrol. 2009;20:1103-1112. Epub 2009 Apr 15 7. Ong LM, Hooi LS, Lim TO, Goh BL, et al. Randomized controlled trial of pulse intravenous cyclophosphamide versus mycophenolate mofetil in the induction therapy of proliferative lupus nephritis. Nephrology (Carlton). 2005;10:504-510.
www.m edscape.com /viewarticle/734165_print 2/3
6/23/13
Abstract 8. Houssiau FA, D'Cruz D, Sangle S et al; MAINTAIN Nephritis Trial Group Azathioprine versus mycophenolate mofetil for long-term immunosuppression in lupus nephritis: results from the MAINTAIN Nephritis Trial. Ann Rheum Dis. 2010;69:2083-2089. Epub 2010 Sep 10. Medscape Nephrology 2010 WebMD, LLC
Cite this article: Lynda A. Szczech. Glomerulonephritis 2010: Comparing New Therapeutics to Old. Medscape. Dec 15, 2010.
3/3