Background Mycophenolate mofetil (MMF) and azathioprine (Aza) has long been used as maintenance immunosuppressive treatment for lupus nephritis. However, the benefits of MMF was limited by its high cost in China. Unpredictable severe pancytopenia induced by Aza is not common but may be fetal. Optimal therapeutic modalities with more cost-effectiveness and safety were required to be identified and thus modify the immunotherapeutic strategies. Tripterygium wilfordii multiglycoside (GTW), an authorized Chinese patent drug, has been used for the treatment of autoimmune diseases for decades in China. We retrospectively reviewed 326 patients with proliferative lupus nephritis who received MMF, Aza or GTW as long-term maintenance agents in this study, compared the efficacy among these three groups and observed side effects of the medication.
Objectives To evaluate the outcome and side effects of Tripterygium wilfordii multiglycoside as long-term maintenance therapy in the treatment of systemic lupus erythematosus.
Methods We retrospectively reviewed 326 patients with proliferative lupus nephritis between 2000 and 2006 in south China who received MMF, Aza or Tripterygium wilfordii multiglycoside as maintenance regimen. After a short course of intravenous cyclophophamide as induction therapy according to the NIH protocol, MMF (target dose: 2 g/day), AZA (target dose: 2 mg/kg/day) or GTW (target dose: 1.8 g/day) was administrated. Steroids and antimalarial drugs were continued if necessary. The patients were followed up till October 2011. Details of the clinical presentation (renal remission, disease remission, the occurrence of renal relapse, chronic renal failure and death, etc), serological, immunological variables and side effects were collected.
Results No significance of demographic variables was found among MMF group (115 cases), Aza group (91 cases) and GTW group (120 cases). Significant renal parameter improvements were observed in all patients after induction therapy. GTW group had a similar probability of remaining remission and renal function improvement or stabilization in five years to AZA group (77% in GTW group and 74% in AZA group). Time to severe systemic flare, benign flare and glucosteroid withdrawal were similar between the two groups. MMF was superior to GTW and AZA (87% in MMF group). Skin and joint involvements were best controlled in GTW group. Drug related toxicities were similar except that cytopenias were more common in AZA group.
Conclusions GTW was as effective as AZA in the long-term maintenance treatment of proliferative lupus nephritis. Fewer renal flares were identified in the patients received MMF. GTW was a reasonable consideration for patients unwilling to take MMF. Promising toxicity profile was observed in GTW.
Comparison of toxic reaction of Tripterygium wilfordii multiglycoside in normal and adjuvant arthritic rats. J Ethnopharmacol. 2011; 135 (2): 270-7.
Disclosure of Interest None Declared