Which Pill to Pop for Kidney Protection?

CellCept for lupus nephritis may be better drug than Imuran

(RxWiki News) Lupus can cause problems in many different parts of the body, including the kidneys. Patients with kidney complications are usually treated with medications. But which drug treatment works best?

CellCept (mycophenolate mofetil) is a more effective drug for controlling kidney complications in lupus patients, compared to another commonly used drug called Imuran (azathioprine).

"Talk to your doctor about CellCept to prevent kidney complications."

When lupus affects the kidneys, it is called lupus nephritis. Maintenance therapy - or therapy to prevent a relapse - for lupus nephritis often involves Imuran or CellCept. Mary Anne Dooley, M.D., M.P.H., of the University of North Carolina at Chapel Hill, and colleagues wanted to see which drug was the best treatment.

Lupus, or systemic lupus erythematosus, is an autoimmune disease, which means it happens when the body's immune system mistakenly attacks your own healthy tissues and organs. When lupus attacks the kidneys, it is called lupus nephritis. Over time, lupus nephritis can lead to blood and protein in the urine, lower kidney function, and kidney failure.

In order to stop these complications, drugs like Imuran and CellCept are sometimes used. Both of these drugs are immunosuppressants, meaning they prevent activity of the immune system. In other words, Imuran and CellCept are designed to keep your immune system from attacking healthy organs like your kidneys.

Through their research, Dr. Dooley and her fellow researchers found that CellCept prevented relapses of lupus nephritis more effectively than Imuran. Treatment failed in 32.4 percent of patients taking Imuran, whereas treatment failed in only 16.4 percent of those taking CellCept.

"Mycophenolate mofetil was superior to azathioprine in maintaining a renal response to treatment and in preventing relapse in patients with lupus nephritis who had a response to induction therapy," the authors write.

While many patients in both groups experienced adverse events such as minor infections and gut disorders, serious adverse events were more common in those taking Imuran. About 33 percent of Imuran patients had serious adverse events, compared to 23.5 percent of patients taking CellCept.

It was also much more common for patients in the Imuran group to withdraw from the study because of adverse events, compared to patients in the CellCept group.

For their study, the researchers followed 227 patients for 36 months. They assigned the participants to take either CellCept or Imuran once a day. To assess each drug's effectiveness, the researchers measured the time until treatment failure. Treatment failure was defined as death, end-stage renal disease, a twofold increase in serum creatinine level, renal flare, or the use of rescue therapy for lupus nephritis. The researchers also recorded harmful events.

The study - which was funded by Vifor Pharma - is published in the New England Journal of Medicine.

Review Date: 
November 21, 2011