Most Read Articles
01 Nov 2013

Joint stiffness is defined as discomfort after a period of inactivity. It is associated with reduced or loss of range of motion in a joint.

Stephen Padilla, 25 Nov 2016
The addition of supervised physiotherapy to usual care does not provide clinically important improvement in the management of simple ankle sprains in a general population of patients seeking hospital-based acute care, according to results of a recent randomized controlled trial.
24 Jul 2017
The toxic side-effects of chemotherapy appear to be induced by cell-free chromatin (cfCh) fragments released from dying cells, triggering DNA damage, apoptosis and inflammation in healthy cells, thereby exaggerating or amplifying the toxic effects caused by the drugs themselves, according to a study.

Mycophenolate sodium superior to azathioprine in lupus patients

Jairia Dela Cruz
09 May 2017

Enteric-coated mycophenolate sodium (EC-MPS) appears to be more effective than azathioprine (AZA) at inducing long-term clinical remission and preventing relapse in patients with active systemic lupus erythematosus (SLE), according to the results of an open-label trial.

A total of 240 patients were randomized to receive either EC-MPS at 1,440 mg/day (n=120; mean age 42.1 years; 90 percent female) or AZA at 2/mg/kg/day (n=120; mean age 40.9 years; 92.5 percent female) in addition to prednisone and/or antimalarials. Treatment lasted 24 months.

The primary endpoint of the proportion of patients achieving clinical remission (SLE Disease Activity Index 2000=0) was found to be greater in the EC-MPS than in the AZA arm at months 3 (32.5 vs 19.2 percent; treatment difference, 13.3; 95 percent CI, 2.3 to 24; p=0.034) and 24 (71.2 vs 48.3 percent; treatment difference, 22.9; 10.4 to 34.4; p<0.001). [Ann Rheum Dis 2017;doi:10.1136/annrheumdis-2016-210882]

EC-MPS also showed superiority in terms of relapse prevention. The occurrence of British Isles Lupus Assessment Group (BILAG) flares was less frequent when compared to AZA (BILAG A/B [moderate-to-severe]: 50 vs 71.7 percent; p=0.001; BILAG B [moderate]: 8.3 vs 21.67 percent; p=0.004).

Researchers said EC-MPS reduced the risk of developing any SLE flare and severe flare by 45 and 65 percent, respectively.

Moreover, time to clinical remission (hazard ratio [HR], 1.43; 1.07 to 1.91; p=0.017) and time to first BILAG A/B flare (HR, 1.81; 1.3 to 2.56; p=0.0004) and BILAG A flare (HR, 2.84; 1.37 to 5.89; p=0.003) were better with EC-MPS vs AZA.

In terms of safety, “[t]he occurrence of AEs [59.2 vs 57.5 percent with EC-MPS and AZA, respectively] and serious events [serious infections, 4.2 vs 5.8 percent] was similar in both groups except for gastrointestinal side effects, including liver toxicity, and haematological events, which were more common in the AZA group, consistent with previous findings,” researchers noted. [Rheumatology 2010;49:723–32; N Engl J Med 2011;365:1886–95; Ann Rheum Dis 2010;69:2083–9]

A chronic multisystem autoimmune disease, SLE is characterised by heterogeneous clinical manifestations and a relapsing–remitting course. The present data indicate that EC-MPS is superior to AZA, which is one of the most frequently used immunosuppressants, in achieving long-term clinical remission and in preventing relapse in patients with active nonrenal lupus disease, they said. [N Engl J Med 2008;358:929–39]

“Despite AZA being shown to be less effective, its safety profile during pregnancy is a significant advantage over EC-MPS. Mycophenolate mofetil [MMF] and EC-MPS are absolutely contraindicated,” they continued.

“MMF is likely to be a human teratogen based on the reported malformations observed among exposed offspring (microtia, orofacial clefts, external auditory canal atresia and cardiovascular malformations). When long-term immunosuppression is required in young women planning pregnancy this issue needs to be considered,” they said. [Am J Med Genet A 2009;149A:1241–8]

Researchers cited several study limitations, such as the inclusion of mainly Caucasian patients rather than a large international multiethnic population, the open-label design, and the failure to routinely perform serum measures of the active metabolites of AZA or EC-MPS.

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Most Read Articles
01 Nov 2013

Joint stiffness is defined as discomfort after a period of inactivity. It is associated with reduced or loss of range of motion in a joint.

Stephen Padilla, 25 Nov 2016
The addition of supervised physiotherapy to usual care does not provide clinically important improvement in the management of simple ankle sprains in a general population of patients seeking hospital-based acute care, according to results of a recent randomized controlled trial.
24 Jul 2017
The toxic side-effects of chemotherapy appear to be induced by cell-free chromatin (cfCh) fragments released from dying cells, triggering DNA damage, apoptosis and inflammation in healthy cells, thereby exaggerating or amplifying the toxic effects caused by the drugs themselves, according to a study.