Lupus nephritis is an inflammatory condition affecting the kidneys which is caused by systemic lupus erythematosus (SLE), an autoimmune disease that is more common among women. About half of all people with SLE develop lupus nephritis, and of these about 1/10 experience chronic kidney disease or kidney failure. Treatment aims to delay disease progression and achieve remission by stabilising and improving kidney function and minimising side effects. For about the past 30 years, standard treatment for lupus nephritis has focused on a combination of cyclophosphamide (an alkylating agent) and corticosteroids.
We found that the drug mycophenolate mofetil (MMF) was as effective as cyclophosphamide in combination with corticosteroids in achieving remission in people with lupus nephritis. MMF has fewer harmful effects including ovarian failure, decreased ability to fight infections (leucopenia) and hair loss (alopecia). MMF was superior to azathioprine (an immunosuppressive drug) in combination with corticosteroids at preventing renal relapse when used as maintenance therapy.