High plasma mycophenolate acid concentration in the early phase of induction therapy predicts good renal outcome in lupus nephritis

Tomofumi Kiyokawa, Hironari Hanaoka, Harunobu Iida, Kana Ishimori, Yukiko Takakuwa, Takahiro Okazaki, Shoichi Ozaki, Kimito Kawahata

Research output: Contribution to journalArticle

Abstract

Objectives: To identify the prognostic predictive factor of complete renal response (CR) at week 12 by focusing on the plasma mycophenolic acid (MPA) concentration in induction therapy in lupus nephritis. Methods: We prospectively enrolled patients with biopsy-proven LN class III/IV who were hospitalized between 2016 and 2017. As an induction therapy, mycophenolate mofetil was continuously introduced at 2000 mg/day. We measured the MPA plasma concentration at two time points depending on the induction therapy phase, early (week 4) or middle (week 12). The association between these concentrations and CR rate at week 12 was evaluated. Results: Ten patients were enrolled. A significantly higher AUC0–12 between 0 and 12 h of MPA at the early phase was observed in the patients with CR at week 12 than in those without (p =.03). All the patients with high MPA-AUC0–12 (> 40 mg h/L) at the early phase achieved CR at week 12, but no such association was found at the middle phase. The multivariate analysis revealed that MPA-AUC0–12 was selected as an independent predictive factor of CR at week 12 (odds ratio: 1.12; 95% confidence interval: 1.01–1.45, p =.02). Conclusion: The high AUC0–12 of MPA at the early phase of induction therapy may predict good renal response.

Original languageEnglish
JournalModern Rheumatology
DOIs
Publication statusPublished - 2019 Jan 1
Externally publishedYes

Fingerprint

Mycophenolic Acid
Lupus Nephritis
Kidney
Acids
Therapeutics
Multivariate Analysis
Odds Ratio
Confidence Intervals
Biopsy

Keywords

  • Lupus nephritis
  • mycophenolate mofetil
  • mycophenolic acid
  • therapeutic drug monitoring

ASJC Scopus subject areas

  • Rheumatology

Cite this

High plasma mycophenolate acid concentration in the early phase of induction therapy predicts good renal outcome in lupus nephritis. / Kiyokawa, Tomofumi; Hanaoka, Hironari; Iida, Harunobu; Ishimori, Kana; Takakuwa, Yukiko; Okazaki, Takahiro; Ozaki, Shoichi; Kawahata, Kimito.

In: Modern Rheumatology, 01.01.2019.

Research output: Contribution to journalArticle

Kiyokawa, Tomofumi ; Hanaoka, Hironari ; Iida, Harunobu ; Ishimori, Kana ; Takakuwa, Yukiko ; Okazaki, Takahiro ; Ozaki, Shoichi ; Kawahata, Kimito. / High plasma mycophenolate acid concentration in the early phase of induction therapy predicts good renal outcome in lupus nephritis. In: Modern Rheumatology. 2019.
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abstract = "Objectives: To identify the prognostic predictive factor of complete renal response (CR) at week 12 by focusing on the plasma mycophenolic acid (MPA) concentration in induction therapy in lupus nephritis. Methods: We prospectively enrolled patients with biopsy-proven LN class III/IV who were hospitalized between 2016 and 2017. As an induction therapy, mycophenolate mofetil was continuously introduced at 2000 mg/day. We measured the MPA plasma concentration at two time points depending on the induction therapy phase, early (week 4) or middle (week 12). The association between these concentrations and CR rate at week 12 was evaluated. Results: Ten patients were enrolled. A significantly higher AUC0–12 between 0 and 12 h of MPA at the early phase was observed in the patients with CR at week 12 than in those without (p =.03). All the patients with high MPA-AUC0–12 (> 40 mg h/L) at the early phase achieved CR at week 12, but no such association was found at the middle phase. The multivariate analysis revealed that MPA-AUC0–12 was selected as an independent predictive factor of CR at week 12 (odds ratio: 1.12; 95{\%} confidence interval: 1.01–1.45, p =.02). Conclusion: The high AUC0–12 of MPA at the early phase of induction therapy may predict good renal response.",
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