Association of mycophenolate and azathioprine use with cognitive function in systemic lupus

Chrisanna Dobrowolski, John McGinley, Melissa Fazzari, Jiandong Su, Kathleen S. Bingham, Nicole Anderson, Lesley Ruttan, Dorcas E. Beaton, Joan E. Wither, Maria Carmela Tartaglia, Mahta Kakvan, Dennisse Bonilla, May Y. Choi, Marvin J. Fritzler, Juan Pablo Diaz Martinez, Patricia Katz, Robin Green, Chaim Putterman, Zahi Touma

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objectives: Cognitive dysfunction (CD) is a common manifestation of SLE that can have detrimental consequences for those affected. To date, no treatments have been approved for SLE-CD. This study aims to assess the association of azathioprine (AZA) and mycophenolate (MMF) use with SLE-CD, given that these medications have demonstrated neuroprotective qualities in prior studies. Methods: Consecutive adult SLE patients presenting to a single healthcare center were considered for participation. The ACR neuropsychological battery for SLE was administered to consenting patients at 0, 6 and 12 months. Scores were compared with age-And sex-matched controls. Primary outcome was CD, defined as a z-score ≤-1.5 in two or more cognitive domains. Mixed-effects logistic regression models were constructed to estimate the odds of CD with respect to AZA and MMF use. Results: A total of 300 participants representing 676 patient visits completed the study; 114 (38%) met criteria for CD at baseline. The cumulative AZA dose (g/kg) was associated with reduced odds of CD [odds ratio (OR) 0.76 (95% CI 0.58, 0.98), P = 0.04]. Years of AZA treatment was also associated with reduced odds of CD [OR 0.72 (95% CI 0.54, 0.97), P = 0.03]. MMF use was not associated with CD. Conclusion: AZA use was associated with significantly lower odds of SLE-CD, while MMF use was not. Additional studies are warranted to further investigate the relationship of AZA and SLE-CD.

Original languageEnglish
Pages (from-to)1860-1869
Number of pages10
Issue number5
StatePublished - 1 May 2023
Externally publishedYes

Bibliographical note

Funding Information:
This project was funded by the National Institutes of Health/National Center for Advancing Translational Science (Einstein-Montefiore CTSA grant UL1TR002556)

Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.


  • AZA
  • SLE
  • cognition
  • mycophenolate
  • neuropsychiatric SLE


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