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Induction of remission in active anti-neutrophil cytoplasmic antibody-associated vasculitis with mycophenolate mofetil in patients who cannot be treated with cyclophosphamide Stassen PM; Tervaert JW; Stegeman CAAnn Rheum Dis 2007[Jun]; 66 (6): 798-802BACKGROUND: Active anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) is commonly treated with cyclophosphamide, a drug with serious side effects, and with corticosteroids. OBJECTIVE: To determine the efficacy of a possible alternative drug for cyclophosphamide, oral mycophenolate mofetil (MMF) 1000 mg twice daily and oral prednisolone 1 mg/kg once daily as remission induction treatment. METHODS: 32 consecutive patients with 34 episodes of active vasculitis who could not be treated with cyclophosphamide were diagnosed for a median (range) of 6.0 (0.3-22) years and experienced 4 (0-14) relapses prior to the current episode. Treatment response and relapse-free survival were analysed. RESULTS: Complete remission (CR) was obtained in 25 (78%) patients, partial remission (PR) in 6 (19%), whereas 1 (3%) patient did not respond. 19 patients relapsed, 13 (52%) after CR, 14 (3-58) months after starting the treatment and 6 (100%) after PR, 6 (2-10) months after starting the treatment. The median relapse-free survival was 16 months, comparable with the interval between the previous relapse and the current MMF-treated relapse (17 (3-134) months). Relapse-free survival at 1, 3, and 5 years was 63%, 38% and 27%, respectively. Patients who had been treated successfully with cyclophosphamide before responded better (CR 84%, relapse 50%) than those who had not (CR 50%, relapse 100%). Minor gastrointestinal side effects and infections occurred frequently. MMF was prematurely discontinued due to adverse effects in two patients. CONCLUSION: MMF, in combination with prednisolone, can induce remission in patients with relapses of AAV intolerant to cyclophosphamide.|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Antibodies, Antineutrophil Cytoplasmic/*blood[MESH]|Autoimmune Diseases/*drug therapy/immunology[MESH]|Contraindications[MESH]|Cyclophosphamide[MESH]|Disease-Free Survival[MESH]|Drug Therapy, Combination[MESH]|Female[MESH]|Follow-Up Studies[MESH]|Humans[MESH]|Immunosuppressive Agents/*therapeutic use[MESH]|Male[MESH]|Middle Aged[MESH]|Mycophenolic Acid/*analogs & derivatives/therapeutic use[MESH]|Prednisolone/therapeutic use[MESH]|Recurrence[MESH]|Remission Induction[MESH]|Treatment Outcome[MESH]|Vasculitis/*drug therapy/immunology[MESH] |
