New research findings indicate that weaning mycophenolate mofetil could be a safe practice in patients with stable SLE.
In a randomised controlled trial published in The Lancet Rheumatology, mycophenolate mofetil withdrawal in patients with quiescent SLE was not significantly inferior to continued maintenance therapy with the immunosuppressive.
After 6.6 years on mycophenolate mofetil therapy, weaning patients off of the drug over three months did not result in significantly increased rates of disease reactivation over 60 months compared with maintenance therapy, although there was a slight increase in flare risk, results showed.
For the multicentre, open-label study, patients aged between 18 and 70 years old with a clinical SLEDAI score of less than 4 at baseline on stable mycophenolate mofetil therapy were randomised to a withdrawal arm, in which the drug was tapered over 12 weeks, or a maintenance group, who continued taking their baseline dose for 60 weeks.
Researchers reported a 6-8% increase with upper 85% confidence limits spanning 11-19% in clinically significant disease reactivation and flare risk in the withdrawal versus maintenance arms.
“Clinicians can be reasonably confident that the actual increases in risks for the population range from 11% or lower for BILAG A to 19% or lower for any SELENA-SLEDAI flare,” they said.
“When considering mycophenolate mofetil withdrawal, clinicians and patients must decide if these upper limits fall within personal levels of acceptable risk”.
Of note, the team also found that the risk of disease activation was higher, and confidence limits wider, in patients with a history of renal involvement, although the difference was not statistically different when compared to the entire trial population.