June 12, 2019

A study presented at EULAR showed that ongoing maintenance therapy with the immunosuppressive drug cyclosporine helped lower proteinuria — the level of protein in urine — faster than other immunosuppressive drugs mycophenolate mofetil or azathioprine in people with lupus nephritis.  The three were comparable in their ability to cause remission of Lupus Nephritis over the long term.

The study involved 96 patients with Lupus Nephritis. At six months 30 patients started maintenance therapy with cyclophosphamide, 32 with mycophenolate mofetil and 34 with azathioprine.  Level of protein in the urine was one of the measures use to evaluate complete, partial or no response to treatment and was higher in the beginning of the study in the group who were later treated with cyclosporine.

At 1 year, after 6 months of maintenance therapy, in the cyclosporine group the percentage of patients in complete remission was 73% compared with 65.6% among patients receiving mycophenolate mofetil and 40% among those treated with azathioprine.  At 5 years it was 80% of patients had complete remission compared with 83% of patients on either mycophenolate mofetil or azathioprine and 88% of those on cyclosporine at 10 years vs 70% in those treated with mycophenolate mofetil and 68% of those receiving azathioprine.

“Our study is the first to compare these three drugs as maintenance therapy in the long term,” said Lorenza Maria Argolini, Rheumatology Consultant of the Lupus Clinic, ASST Pini CTO, Milan, Italy.  “After 10 years of observation, cyclosporine, azathioprine and mycophenolate mofetil have proven to be effective in consolidating and maintaining the remission of Lupus Nephritis.”

“Of interest are the results achieved in the cyclosporine group. Despite worse clinical conditions at the beginning of maintenance therapy, cyclosporine allowed a rapid achievement of LN remission in the great majority of pts compared to azathioprine and mycophenolate mofetil.”