ANCA-associated vasculitis: mycophenolate mofetil vs cyclophosphamide

  • Jones RB & al.
  • Ann Rheum Dis
  • 5 Jan 2019

  • curated by Dawn O'Shea
  • UK Medical News
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Mycophenolate mofetil (MMF) induction therapy may be a suitable alternative to cyclophosphamide (CYC) in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), according to the European Vasculitis Study Group (EUVAS).

Small studies have suggested that MMF has efficacy for remission induction in AAV, particularly in myeloperoxidase (MPO)-ANCA disease. The treatment has the added benefits of having a short duration of action; can be used in renal disease, unlike rituximab; and unlike CYC, is not associated with urothelial malignancy or infertility.

EUVAS has published the findings of a new randomised controlled trial, which investigated whether MMF was non-inferior to CYC for remission induction in AAV. The trial, led by the Universities of Birmingham and Cambridge, included 140 newly diagnosed patients, randomly assigned to MMF or pulsed CYC. All patients received the same oral glucocorticoid regimen and were switched to azathioprine following remission.

MMF was found to be non-inferior to CYC in achieving remission by 6 months requiring compliance with the tapering glucocorticoid regimen. In the MMF group, 67% achieved remission compared to 61% in the CYC group.

However, there were more relapses occurred in the MMF group compared with the CYC group (33% vs 19%; incidence rate ratio, 1.97; 95% CI, 0.96-4.23; P=.049). In MPO-ANCA patients, relapses occurred in 12% receiving CYC and 15% receiving MMF.

In proteinase 3-ANCA patients, relapses occurred in 24% receiving CYC and 48% receiving MMF.

The authors concluded that MMF is a potential alternative to CYC for remission induction in non-life-threatening AAV, particularly in patients with low predicted relapse risk, such as elderly patients who are MPO positive.