Assessment of the Potential Impact of Mycophenolate Mofetil on Lowering Renal Biomarkers in Patients with Class III Lupus Nephritis: A Pilot Study to Predict Renal Function Progress

Background: Lupus nephritis (LN) is a potentially severe complication of systemic lupus erythematosus (SLE). Mycophenolate mofetil (MMF) is an oral immunosuppressive agent used in lupus patients who are intolerant of or refractory to other conventional therapies. The aim of this study was to assess the potential effect of MMF on lowering some biomarkers as a predictive of renal function in patients with Class III LN. Methods: This was a single-center, prospective cohort study that enrolled patients with Class III LN who received 2 g/day of oral MMF. The potential impact of MMF on renal biomarkers was evaluated at baseline and subsequently at 3-month intervals for 6 months according to changes in antinuclear antibodies (ANA), antidouble stranded deoxyribonucleic acid (anti-dsDNA), elastase α-1 proteinase inhibitor (α-1 PI), proteinuria, and the urine protein-to-creatinine ratio (P/C ratio). Results: A significant decrease over the course of MMF treatment compared to the baseline regarding ANA (1.37 ± 0.47 vs. 2.90 ± 1.05, P = 0.03); anti-dsDNA (23.39 ± 3.19 vs. 39.91 ± 8.1 IU/mL, P = 0.02); elastase α-1 PI (512.4 ± 74.12 vs. 696.35 ± 105.35 ng/mL, P = 0.03); proteinuria (0.25 ± 0.44 vs. 1.95 ± 0.76 g/24 h., P = 0.01); and P/C ratio (0.20 ± 0.22 vs. 1.37 ± 0.26, P = 0.04). Conclusion: MMF is effective in lowering renal biomarkers of Class III LN revealed by a significant reduction in ANA, anti-dsDNA, elastase α-1 PI, proteinuria, and P/C ratio over 6 months of MMF treatment. Keywords: Elastase α-1 proteinase inhibitor, lupus nephritis, mycophenolate mofetil, renal biomarkers