ABSTRACT

Lupus nephritis (LN) is the most common severe manifestation of systemic lupus erythematosus (SLE) affecting approximately 35-60%of patients during the disease course and is a cause of increased morbidity and mortality associated with end-stage renal disease. Optimal management of lupus renal disease is still subject to discussion since the presentation and the course is so heterogeneous. Although cyclophosphamide (Cyc) has long been considered as a gold standard in the treatment of proliferative LN, its side-effects and the fact that there is still a considerable number of patients who are refractory to CYC and who relapse under this treatment, have directed clinicians to find more effective and safer therapies. Mikofenolat mofetil (MMF) has emerged as such an effective and safe alternative that can be used in proliferative LN. This review provides a summary of large randomised controlled studies and meta-analyses about the place of MMF in the induction and maintenance therapies of severe LN.