黴菌酚酸（mycophenolic acid）治療狼瘡性腎炎的臨床經驗

Clinical efficacy of mycophenolic acid in the treatment of lupus nephritis

目的：近期的研究已證實在狼瘡性腎炎急性誘導期使用口服黴菌酚酸（MMF或MPA），其效果和環磷醯胺（CYC）脈衝療法類似或更好但副作用顯著減少。在台灣，探討狼瘡性腎炎病患的療效及安全治療劑量之相關研究很少。方法：收集門診37位狼瘡腎炎患者，依據其服用黴菌酚酸劑量分成兩組並收集實驗室檢查報告，包括全血細胞計數、血清肌酸酐、白蛋白、補體、抗雙鏈去氧核糖核酸抗體，及二十四小時尿蛋白。回溯性分析這二組病患使用MMF/MPA類藥物後之治療反應及副作用。結果：每日口服MMF 1克或MPA 720毫克這一組有26人，另一組每日口服MMF 2 克或MPA 1440 毫克有11人。在這兩組中，第12和24週各有1人達到完全緩解（CR）。第一組在第12週達到部分緩解（PR）有33%，第24週有43%。第二組在第12週達到部分緩解（PR）有67%，第24週有75%。這兩組的血清肌酸酐下降百分比在第12週為5%和20% （p=0.02），第24週為0%和26% （p=0.007）。除了血清肌酸酐下降百分比之外，這兩組數據在二十四小時尿蛋白、血清白蛋白、補體、和抗雙鏈去氧核糖核酸抗體都未達到統計學上的意義，但卻有明顯改善的趨勢，而且都沒有嚴重的副作用。結論：我們的研究發現使用MMF 2g/day或MPA 1440mg/day治療的這一組病人，有較好的療效。

Objective: To demonstrate the efficacy and safety of mycophenolic acid (MPA) as an induction therapy for lupus nephritis (LN) due to the availability of limited data in Taiwan. Materials and Methods: This retrospective study included subjects who were treated with MPA for LN at the rheumatology outpatient clinic in Chang Gung Memorial Hospital-Kaohsiung and Linkou Medical Centers between January 2005 and July 2007. Subjects were categorized into 2 groups according to the dose of MPA. We measured complete blood count (CBC), levels of serum creatinine (Scr), albumin, complement (C3 and C4), anti-double-stranded DNA (anti-dsDNA) antibody titer, and daily urinary protein at the baseline, 12 weeks, and 24 weeks after MPA therapy, and therapeutic response and adverse effects were analyzed. Results: A total of 37 subjects were enrolled: 26 in group I (Gr I) and 11 in group II (Gr II). At both 12 and 24 weeks, 1 subject from each group achieved a complete response (CR). One-third of the subjects in Gr I achieved partial response (PR) at 12 weeks and 43% achieved it at 24 weeks, while 67% and 75% of subjects in Gr II achieved CR at 12 and 24 weeks, respectively. Except for a significant improvement in percent changes in the Scr levels in Gr II, the changes in the daily urinary protein, serum albumin, complement, and anti-dsDNA levels of both the groups were not statistically significant but showed a similar trend of improvement. Only one serious adverse event occurred in each group. Conclusions: Compared to treatment with mycophenolate mofetil (MMF) at 1 g/day or MPA at 720 mg/ day, treatment with either MMF at 2 g/day or MPA at 1440 mg/day had a better therapeutic effect on LN. In general, the regimen followed in our investigation was safe.