Mycophenolate Mofetil versus Intravenous Cyclophosphamide for Proliferative Lupus Nephritis in Asian Women: An Evidence-Based Approach to Fertility Preservation and Infection Mitigation

This Evidence-Based Clinical Report evaluates the comparative efficacy and safety of mycophenolate mofetil (MMF) versus intravenous cyclophosphamide (IV CYC) as induction therapy for proliferative lupus nephritis, with a specific focus on Asian women of reproductive age. While IV CYC remains a traditional cornerstone of treatment, its cumulative gonadotoxicity and myelosuppressive effects pose severe risks to fertility and immune competence. Through a rigorous critical appraisal of high-quality systematic reviews and meta-analyses using AMSTAR 2, ROBIS, and GRADE frameworks, this report demonstrates that MMF provides non-inferior, and potentially superior, rates of complete renal remission. More importantly, MMF exhibits a significantly optimized safety profile characterized by a dramatic reduction in premature ovarian failure, amenorrhea, and severe infections, particularly when utilizing dose regimens tailored to Asian demographics. Ultimately, this synthesis establishes a robust clinical justification for transitioning to MMF as a definitive, fertility-sparing, and life-saving intervention for severe lupus nephritis flares.