Article Text

other Versions

Induction of remission in active ANCA-associated vasculitis with mycophenolate mofetil in patients who cannot be treated with cyclophosphamide
  1. Patricia M. Stassen (p.m.stassen{at}
  1. Department of Nephrology, University Medical Center Groningen, University of Groningen, Netherlands
    1. Jan Willem Cohen Tervaert (jw.cohentervaert{at}
    1. Department of Clinical Immunology, University of Maastricht, Netherlands
      1. Coen A Stegeman (c.a.stegeman{at}
      1. Department of Nephrology, University Medical Center Groningen, University of Groningen, Netherlands


        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.

        • ANCA-associated vasculitis
        • induction
        • mycophenolate mofetil
        • therapy

        Statistics from

        Request permissions

        If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.