Micofenolato de mofetilo en nefritis lúpica refractaria a ciclofosfamida intravenosa

Daza, Leonel; Pérez, Salvador; Velasco, Ulises; Hernández, Martha

doi:10.1016/S1699-258X(06)73055-8

Información del artículo

Objetivo

Evaluar el uso del micofenolato de mofetilo (MMF) en pacientes con nefropatía lúpica (NL) y fracaso al tratamiento inicial con ciclofosfamida intravenosa (i.v.), durante un período de 12 meses.

Pacientes y métodos

Se incluyeron 11 pacientes con NL. La dosis de MMF fue de 1,5-2 g/día. Se midieron la depuración de creatinina, creatinina sérica y proteinuria en orina de 24 h; asimismo, se anotaron los episodios adversos con el tratamiento durante los 12 meses.

Resultados

La proteinuria basal disminuyó con MMF de 1,63 (intervalo de confianza [IC] del 95%, 0,78-2,5) a 0,93 g/l (IC del 95%, 0,1-1,62) en el doceavo mes, con un valor de p = 0,04. La depuración de creatinina tuvo una tendencia a la mejoría, sin embargo no hubo diferencia estadística, 69,2 (IC del 95%, 51,4-87,4) frente a 79,29 ml/min (IC del 95%, 49,2-109,3), con una p = 0,90. Las demás variables no mostraron diferencias significativas. Los pacientes que no respondieron a MMF tuvieron los índices de cronicidad más altos que los pacientes con respuesta buena o regular.

Conclusión

El MMF a dosis de 1,5-2,0 g/día es una buena alternativa en la NL con bajos índices de cronicidad y con fallo a la ciclofosfamida i.v., sin efectos colaterales graves.

Palabras clave:

Nefritis lúpica

Micofenolato mofetilo

Ciclofosfamida

Lupus eritematoso generalizado

Objective

To evaluate the use of mycophenolate mofetil (MMF) in lupus nephritis (LN) patients with prior failure to intravenous cyclophosphamide over a 12-month follow-up.

Patients and methods

Eleven patients with LN were included. MMF doses ranged from 1.5-2 grams per day. In all patients, 24-h urinary protein excretion, creatinine clearance, and serum creatinine were evaluated. Treatment-related adverse effects were recorded over the 12-month follow-up.

Results

Basal proteinuria decreased from 1.63 g/L (95% CI: 0.78-2.5) to 0.93 (95% CI: 0.1-1.62) g/L at the end of the follow-up period (p = 0.04). Creatinine clearance showed a tendency to improve but no statistically significant differences were found, 69.2 (95% CI 51.4- 87.4) vs. 79.29 (IC 95% 49.2-109.3) ml/min, respectively; p = 0.90). No significant differences were found in the remaining variables. Patients without response to MMF had a higher chronicity index than those with good or average response.

Conclusion

MMF doses of 1.5-2 grams per day are a good alternative in LN patients without response to intravenous cyclophosphamide and a low chronicity index. No severe adverse effects were found.

Key words:

Lupus nephritis

Mycophenolate mofetil

Cyclophosphamide

Systemic lupus erythematosus

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