Mycophenolate versus azathioprine: which one is better for treatment of lupus nephritis?
We read with interest the article by Houssiau, et al , which provided evidence that mycophenolate mofetil (MMF) was not significantly superior to azathioprine (AZA) in preventing renal flares in European patients with lupus nephritis (LN), with a renal relapse rate of 19%, 25% in the MMF, AZA group, respectively. However, inconsistency exists compared with other studies up to now [2-5]. Recently, Dooley, et al  indicated that MMF was superior to AZA in maintaining a renal response to treatment and in preventing relapse in patients with LN, in which patients were mainly from Asia, Latin/North America, Europe. Furthermore, Contreras, et al  substantiated African-Americans with LN had the worst outcome when compared to Hispanics/Caucasians, but the study was not powered to detect small differences in comparison. Moreover, Sahin, et al  showed that both therapeutic approaches with MMF and AZA were effective as a maintenance therapy for LN, without significant differences in Turkey patients. Nevertheless, Tse, et al  found MMF treatment for LN significantly reduce incidence of complications in Asian patients. Therefore, which one is better for treatment of LN is still needed to clarify based on large sample size and different ethnicity in the future.
1. Houssiau FA, D'Cruz D, Sangle S, et al. Azathioprine versus mycophenolate mofetil for long-term immunosuppression in lupus nephritis: results from the MAINTAIN Nephritis Trial. Ann Rheum Dis. 2010;69:2083-9.
2. Dooley MA, Jayne D, Ginzler EM, et al. Mycophenolate versus azathioprine as maintenance therapy for lupus nephritis. N Engl J Med. 2011;365:1886-95.
3. Contreras G, Tozman E, Nahar N, et al. Maintenance therapies for proliferative lupus nephritis: mycophenolate mofetil, azathioprine and intravenous cyclophosphamide. Lupus. 2005;Suppl1:s33-8.
4. Sahin GM, Sahin S, Kiziltas S, et al. Mycophenolate mofetil versus azathioprine in the maintenance therapy of lupus nephritis. Ren Fail. 2008;30:865-9.
5. Tse KC, Tang CS, Lam MF, et al. Cost Comparison between mycophenolate mofetil and cyclophosphamide-azathioprine in the treatment of lupus nephritis. J Rheumatol. 2009;36:76-81.
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