rss
Ann Rheum Dis 2007;66:798-802 doi:10.1136/ard.2006.060301
  • Extended report

Induction of remission in active anti-neutrophil cytoplasmic antibody-associated vasculitis with mycophenolate mofetil in patients who cannot be treated with cyclophosphamide

  1. Patricia M Stassen1,
  2. Jan Willem Cohen Tervaert2,
  3. Coen A Stegeman1
  1. 1Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  2. 2Department of Clinical Immunology, University Hospital Maastricht, Maastricht, The Netherlands
  1. Correspondence to:
    MrsP M Stassen
    Department of Nephrology, University Medical Center Groningen, PO box 30001, 9700 RB Groningen, The Netherlands; p.m.stassen{at}int.umcg.nl
  • Accepted 10 December 2006
  • Published Online First 19 December 2006

Abstract

Background: 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.

Footnotes

  • Published Online First 19 December 2006

  • Competing interests: None.

This Article

  1. Abstract
  2. Full text
  3. PDF
  4. All versions of this article:
    1. ard.2006.060301v1
    2. 66/6/798 most recent

Responses

  1. Submit a response
  2. No responses published

Register for free content

The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.