Induction of remission in active ANCA-associated vasculitis with mycophenolate mofetil in patients who cannot be treated with cyclophosphamide

Patricia M. Stassen ^1*, Jan Willem Cohen Tervaert ² and Coen A Stegeman ¹

¹ Department of Nephrology, University Medical Center Groningen, University of Groningen, Netherlands
² Department of Clinical Immunology, University of Maastricht, Netherlands

^* To whom correspondence should be addressed. E-mail: p.m.stassen{at}int.umcg.nl.

Accepted 10 December 2006

Abstract

Objective: Active anti-neutrophil cytoplasmatic antibody associated vasculitis is commonly treated with cyclophosphamide, a drug with serious side effects, and with corticosteroids. We determined the efficacy of a possible alternative drug for cyclophosphamide, mycophenolate mofetil 2 times 1000 mg and prednisolone 1 mg/kg daily as remission induction therapy.

Methods: Thirty-two consecutive patients with 34 episodes of active vasculitis who could not be treated with cyclophosphamide. Patients were diagnosed 6.0 (median, range 0.3-22) years and experienced 4 (0-14) relapses prior to the current episode. Treatment response and relapse-free survival were analyzed.

Results: Complete remission was obtained in 25 patients (78%), partial remission in 6 (19%), while 1 (3%) did not respond. Nineteen patients relapsed, 13 (52%) following complete remission, 14 (3-58) months after start of therapy, and 6 (100%) following partial remission, 6 (2-10) months after start of therapy. 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 (complete remission 84%, relapse 50%) than those who had not (complete remission 50%, relapse 100%). Minor gastro- intestinal side effects and infections occurred frequently. Mycophenolate mofetil was prematurely discontinued due to adverse effects in 2 patients.

Conclusion: Mycophenolate mofetil, in combination with prednisolone, can induce remission in patients with relapses of ANCA-associated vasculitis intolerant of cyclophosphamide.

Keywords: ANCA-associated vasculitis, induction, mycophenolate mofetil, therapy

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