Mycophenolate Mofetil for Induction and Maintenance of Remission in Microscopic Polyangiitis with Mild to Moderate Renal Involvement—A Prospective, Open-Label Pilot Trial

Abstract

Background and objectives: Microscopic polyangiitis (MPA) is a systemic small-vessel vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA), often targeting myeloperoxidase (MPO). Cyclophosphamide (CYC) plus corticosteroids (CS) is considered standard therapy for patients with renal involvement, but treatment response is not satisfactory in all patients and CYC has well recognized toxicity. This prospective pilot trial explored whether mycophenolate mofetil (MMF) represents an effective alternative to CYC for induction and maintenance of remission in MPA with mild to moderate renal involvement.Design, setting, participants, & measurements: Seventeen P-ANCA/MPO-ANCA-positive patients with MPA with mild to moderate renal involvement received MMF (1000 mg orally, twice daily) and CS (intravenous methylprednisolone, 1 to 3 g, followed by oral prednisone at 1 mg/kg per day). Oral CS were discontinued by month 6; MMF was continued through month 18. The primary outcome measure was remission by month 6 and stable renal function. Secondary endpoints included major relapses necessitating a switch to CYC plus CS, minor relapses requiring an increase in CS dosage, and adverse events.Results: Thirteen of 17 patients enrolled achieved the primary outcome, and 4 failed because of insufficient response, relapse, or MMF intolerance. Twelve patients remained in remission through month 18, renal function remained stable, and proteinuria improved. Side effects of MMF were mild, transient, and responsive to dose adjustments in all patients except one.Conclusions: MMF represents an alternative to CYC for induction and maintenance of remission in patients with MPO-ANCA-associated MPA with mild to moderate renal disease.

Effects of Mycophenolate Mofetil Combined with Corticosteroids for Induction Therapy of Microscopic Polyangiitis

“…Moreover, Chinese AASV patients over 65 years of age had a higher proportion (79.8%) of MPA; these patients had more severe pulmonary complications and responded less well to induction therapy [25]. In the present study, the therapy of MMF combined with prednisone achieved a complete remission rate of 78.9%, similar to the results of Hu et al [10] and Silva et al [11]. Their studies also mainly enrolled MPA patients.…”

“…Pilot case series studies, shown in table 1, reported that induction therapy using MMF resulted in a complete remission rate of 50–81.8% in AASV patients with active diseases [7,8,9,10,11], and sustained remission in 38.7–92.3% of patients [8,12,13,14,15]. However, the highest relapse rate occurred in cases of mainly WG [9].…”

Long-term Outcome and Efficacy of Cyclophosphamide Therapy in Japanese Patients with ANCA-associated Microscopic Polyangiitis: A Retrospective Study

“…Rituximab which is an anti-CD20 monoclonal antibody and mycophenolate mofetil have been recently reported to be efficacious in the treatment of AAV (21)(22)(23)(24). However, the reported efficacy of these drugs is not superior to combined CS and CY therapy.…”

Outcomes of Elderly Patients with Anti-Neutrophil Cytoplasmic Autoantibody-Associated Vasculitis Treated with Immunosuppressive Therapy

“…Despite a greater total immunosuppression burden in younger patients, they were more likely to relapse than older patients (p = 0.004). This may relate to PR3-positivity, which is a major prognostic factor for relapse in AAV as well as renal survival in long-term follow-up [3,7,19,20,21,22]. PR3-positivity and age appear to be independent predictors of a poorer outcome in AAV [8,19].…”