Background Mizoribine (MZB), an inosine monophosphate dehydrogenase inhibitor, is an effective glucocorticoid-sparing agent for gromerulonephritis and variety of rheumatic diseases. However, its clinical usefulness as multi-target therapy in patients of lupus nephritis has been unclear.
Objectives To evaluate efficacy of multi-target therapy with MZB, tacrolimus (TAC) and prednisolone (PSL) for lupus nephritis.
Methods We extracted all the cases with lupus nephritis treated with PSL, MZB, and TAC during period from 2008/1 to 2016/10. Retrospective medical chart review was performed to collect following data; baseline patient characteristics, dose of PSL, serum creatinine, urine protein, compliment, anti-DNA ab, remission rates, and safety profiles. We define complete remission as urine protein <0.5 g/gCre and normal serum creatinine, partial remission as urine protein decreasing more than 50% at baseline, and <3g/day, and normal serum creatinine or increasing within 15%. Patents' records were followed from the beginning of multi-target treatment to 12 months after.
Results 43 cases (female; n=37, male; n=6, mean age; 37.4 years old) were included for analysis. Of 30 cases who underwent renal biopsy, 10 cases were classified as class IV nephritis, and 7 cases were classified as class III nephritis. Mean urine protein (g/gCr) at baseline, at 3 months, and at 6 months are 1.9, 0.4, and 0.4, respectively. Mean dose of steroid was 32.8 mg/day at baseline, 9.8 mg/day at 3 months, and 8.7 mg/day at 6 month. 79.1% of the patients achieved complete remission at 3 months, and the remission rate was more than 80% at 6 months and later. As for adverse events, 14 cases had some Infection, 3 out of 14 needed antibiotics treatment. Four cases had renal impairment after starting TAC, all of them recovered after stopping or decreasing dose of TAC.
Conclusions Multi-target therapy with MZB, TAC and PSL showed good remission rate, and few severe adverse events. We need the further evaluation of long-term efficacy of the therapy.
Disclosure of Interest None declared