A 10-year follow-up of the MAINTAIN Nephritis trial showed no advantage of mycophenolate mofetil (MMF) over azathioprine (AZA) for lupus nephritis (LN) maintenance therapy.

The data confirm the relevance of recommendations from the European Renal Association-European Dialysis and Transplant Association and American College of Rheumatology regarding maintenance therapy of LN, namely that AZA and MMF can be prescribed, stated a research team led by Frédéric A. Houssiau, MD, professor of rheumatology at Universite catholique de Louvain, Brussels, Belgium.

The original MAINTAIN trial randomized 105 mostly Caucasian LN patients to maintenance MMF or AZA in 2002-2006. For the 10-year analysis, the investigators examined long-term outcomes, such as survival, kidney function, 24-hour proteinuria, and renal flares.

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The researchers found that the time to renal flare did not differ between the AZA and MMF patients, according to results published online ahead of print in the Annals of Rheumatic Disease.

Furthermore, they discovered that patients with an early proteinuria decrease of 0.5g/day or less at 12 months have a very low risk of long-term renal impairment at 10 years. (Proteinuria greater than 0.5 g/day was not predictive of poor outcome, however.)

“At the bedside, the clinician can therefore confidently reassure patients who achieve a durable early response in proteinuria but should not consider a switch to an alternative agent based only on non-achievement of this target,” the researchers said.


  1. Tamirou, F, et al. Ann Rheum Dis 2015; doi: 10.1136/annrheumdis-2014-206897.