Efficacy and safety of mizoribine for steroid refractory patients with systemic lupus erythematosus

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  • ステロイド抵抗性全身性エリテマトーデスに対するミゾリビンの効果

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Abstract

Purpose: As mizoribine (MZR) had been the only official immunosuppressive therapy for lupus nephritis in Japan until tacrolimus was admistered in January 2007, efficacy and safety of MZR for steroid refractory patients with systemic lupus erythematosus (SLE) was studied.<br> Methods: We identified the SLE patients treated with MZR. We checked retrospectively the reason for adding MZR, the steroid dose, and the levels of complement and anti-DNA antibody.<br> Results: We found treatment of MZR 44 patients (46 courses) among 197 patients with SLE tracked by our hospital since 1997.The reasons for adding MZR were as follows: difficulty of tapering steroid 11 cases (23.9%), elevation of anti-DNA antibody 27 cases (58.7%), hypocomplementemia 7 cases (15.2%), proteinuria 2 cases (4.3%), skin lesions 5 cases (10.9%), and post-therapy after intra venous cyclophosphamide (IVCY) treatment 8 cases (17.4%). MZR was considered to be effective in 31 cases (70.5%). Hair loss as an adverse effect of MZR was only found in one case. Although MZR treatment was not effective in aggressively relapsed cases and they were treated with more than doubling dose of steroid and/or azathioprine or IVCY, MZR was effective for the patients for whom it was difficult to spare a moderate dose of steroids.<br> Conclusion: MZR is mainly used for the patients with lupus nephritis, kidney transplantation, and rheumatoid arthritis in Japan. This has the characteristics of weak immunosuppressive effect but less adverse effect. In this study we confirmed the efficacy of MZR for mildly relapsed SLE and steroid sparing effect.

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