{
  "abstract": "Objective We aimed to compare the incidence of severe infections between mycophenolate mofetil (MMF) and other immunosuppressants in patients with systemic lupus erythematosus (SLE) on maintenance therapy using data from the Lupus Registry of Nationwide Institutions in Japan.Methods This study employed a prospective cohort design, including patients with SLE undergoing maintenance therapy. Exposure was defined as MMF treatment, and the control group included individuals who received other immunosuppressants (non-MMF) treatments. Severe infections requiring hospitalisation were the primary outcomes, whereas secondary outcomes included all-cause hospitalisation, changes in prednisolone dosage, disease activity and organ damage. Statistical analyses employed marginal structural models with stabilised inverse probability of treatment weighting to adjust for confounders.Results The analysis included 1004 patients; the incidence of severe infections was 6.5% in the MMF group and 7.5% in the non-MMF group, with no significant difference (OR 0.69, 95% CI 0.34 to 1.39). Similarly, all-cause hospitalisation rates were comparable between the groups (OR 0.72, 95% CI 0.47 to 1.09). Prednisolone dosage was significantly reduced in the MMF group (−0.66 mg/day, 95% CI −1.09 to −0.23). The organ damage score was modestly reduced in the MMF group (−0.19 points, 95% CI −0.37 to −0.01), whereas the change of disease activity score was comparable between the groups (−0.10 points, 95% CI −0.74 to 0.55).Conclusions MMF does not significantly increase the risk of severe infections compared with other immunosuppressants in SLE maintenance therapy. MMF may contribute to reducing the dose of prednisolone.",
  "authors": [
    {
      "affiliations": [
        "Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan"
      ],
      "name": "Naoki Matsuoka"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Showa Medical university, Tokyo, Japan",
        "Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan"
      ],
      "name": "Nobuyuki Yajima"
    },
    {
      "affiliations": [
        "Research Administration Center, Showa Medical University, Tokyo, Japan"
      ],
      "name": "Eisuke Inoue"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan"
      ],
      "name": "Shuzo Sato"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan"
      ],
      "name": "Shotaro Ogawa"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan"
      ],
      "name": "Yuya Sumichika"
    },
    {
      "affiliations": [
        "Fukushima Medical University School of Medicine, Fukushima, Japan"
      ],
      "name": "Kenji Saito"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan"
      ],
      "name": "Shuhei Yoshida"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan"
      ],
      "name": "Haruki Matsumoto"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan"
      ],
      "name": "Jumpei Temmoku"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan"
      ],
      "name": "Yuya Fujita"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan"
      ],
      "name": "Tomoyuki Asano"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Showa Medical university, Tokyo, Japan"
      ],
      "name": "Jumpei Fukita"
    },
    {
      "affiliations": [
        "Kochi Medical School, Kochi, Japan",
        "Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan"
      ],
      "name": "Ken-ei Sada"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Shimane University Faculty of Medicine, Shimane, Japan"
      ],
      "name": "Kunihiro Ichinose"
    },
    {
      "affiliations": [
        "Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Kanagawa, Japan",
        "Clinical Laboratory Department, Yokohama City University Hospital, Kanagawa, Japan"
      ],
      "name": "Ryusuke Yoshimi"
    },
    {
      "affiliations": [
        "Center for Rheumatic Diseases, Yokohama City University Medical Center, Kanagawa, Japan"
      ],
      "name": "Shigeru Ohno"
    },
    {
      "affiliations": [
        "Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Saitama, Japan"
      ],
      "name": "Hiroshi Kajiyama"
    },
    {
      "affiliations": [
        "Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Nagano, Japan"
      ],
      "name": "Yasuhiro Shimojima"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Yokohama Rosai Hospital, Kanagawa, Japan"
      ],
      "name": "Michio Fujiwara"
    },
    {
      "affiliations": [
        "Inflammation and Immunology, Kyoto Prefectural University of Medicine, Kyoto, Japan"
      ],
      "name": "Takashi Kida"
    },
    {
      "affiliations": [
        "Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan"
      ],
      "name": "Yoshia Miyawaki"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Tokyo Kyosai Hospital, Tokyo, Japan",
        "Department of Rheumatology, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan"
      ],
      "name": "Yusuke Matsuo"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Kakogawa Central City Hospital, Hyogo, Japan"
      ],
      "name": "Takahisa Onishi"
    },
    {
      "affiliations": [
        "Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan"
      ],
      "name": "Keisuke Nishimura"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan"
      ],
      "name": "Kiyoshi Migita"
    }
  ],
  "title": "Safety of mycophenolate mofetil in systemic lupus erythematosus maintenance therapy: insights from the LUNA registry in a nationwide prospective cohort study",
  "uid": "0c659889-00c4-5ead-9357-63ec3886fbf5"
}