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Delineating the clinical value of MMF for joint manifestations

Comment on: Five-years drug survival of mycophenolate mofetil therapy in patients with systemic lupus erythematosus: comparison between renal and non-renal involvement. Joint Bone Spine 2021 Jun 22;105246. doi: 10.1016/j.jbspin.2021.105246. Online ahead of print

Commented by: Thomas Dörner, Department of Medicine/Rheumatology and Clinical Immunology; Charite Universitätsmedizin Berlin, Germany

While MMF has not been approved for SLE, although recommended by EULAR and widely used as comparator or add-on in lupus nephritis, a recent representative study by Olivieri and colleagues evaluated its value in non-renal SLE in a retrospective analysis of 162 patients over five years.
A number of interesting observations were found. For a follow-up time of 5 years, those comprised a 60.5% retention rate in non-renal and 61.1% for lupus nephritis, respectively. Notably, MMF was preferentially prescribed for arthritis (24.1%) where the retention rate was 75.4% suggesting its clinical value for this organ manifestation as has also been suggested by prior studies. Discontinuation was most frequently found related to remission (21.7%) followed by loss of efficacy (20.5%). A limited evaluation for damage accrual over 12 months MMF treatment could not identify a substantial increase of the SDI in this cohort but warrants further studies.
The interesting lessons of this study are the confirmation that MMF appears to have an impact on non-renal manifestations, namely joint involvement where the retention rate is similar as for lupus nephritis. In addition, the potency of damage prevention remains of interest, although long-term follow-up studies need to address this more carefully.

Reference: Olivieri G, Ceccarelli F, Natalucci F, Pirone C, Orefice V, Pacucci VA, Garufi C, Truglia S, Spinelli FR, Alessandri C, Conti F. Five-years drug survival of mycophenolate mofetil therapy in patients with systemic lupus erythematosus: comparison between renal and non-renal involvement. Joint Bone Spine 2021 Jun 22;105246. doi: 10.1016/j.jbspin.2021.105246. Online ahead of print

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