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June 9, 2003 — Mycophenolate mofetil (MMF) administered
after a rise in antibodies to double-stranded DNA (anti-dsDNA) seems
to prevent relapse in patients with systemic lupus erythematosus
(SLE), according to the results of an open-label pilot study published
in the June issue of the Annals of Rheumatic Diseases.
"Previous studies showed that at least two thirds
of patients develop a clinical relapse within six months after a
significant rise in the anti-dsDNA level, and most relapses were
prevented by the administration of corticosteroids at the time of
the rise," write M. Bijl, and colleagues from University Hospital
in Groningen, the Netherlands. "MMF is a promising new immunosuppressive
drug which has been shown to be effective in the treatment of lupus
nephritis."
The authors monitored 36 SLE patients monthly for
a rise in anti-dsDNA, defined as an increase of 25% of the previous
sample level of at least 15 IU/mL within a four-month period.
Ten patients had a rise in anti-dsDNA and received
six months of treatment with MMF, 2000 mg daily, with minimal adverse
effects. During treatment, none of these patients had a clinical
relapse, antibodies to dsDNA decreased (P < .001), and the state
of activation of CD19+ lymphocytes also decreased. There were no
changes in the state of activation of CD4+ or CD8+ lymphocyte subsets.
Study limitations include differences in serological
methodology compared with other studies and uncontrolled design.
"Administration of MMF after a rise in antibodies
to dsDNA is well tolerated, decreases anti-dsDNA and B cell activation,
and seems to prevent the occurrence of a clinical relapse in patients
with SLE," the authors write. "Whether this treatment is as effective
as a tapering course of corticosteroids has yet to be proved in
a prospective controlled trial."
Roche Pharmaceuticals B.V. provided the study drug.
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