Mycophenolate mofetil versus intravenous pulse cyclophosphamide in induction therapy of crescentic lupus nephritis

Objective:To compare the effect, relapse rate and outcomes between pulse intravenous cyclophosphamide(CTX) and mycophenolate mofetil (MMF) in the induction therapy of crescentic lupus nephritis(CLN) in Chinese. Methodology:Twenty-five CTX treated and twenty-seven MMF treated lupus patients with ≥50% crescent formation were enrolled in this study, who were hospitalized in the Research Institute of Nephrology, Nanjing Jinling Hospital between January 1998 and June 2005. General conditions, clinicopathological findings, remission rate, relapse rate, and outcomes were compared. All the patients were followed-up until June 2005, with an average follow-up in the CTX group for range 10～80(38.5±21.2) months, and range 12～90(41.1±27.0) months in the MMF group. Results:No significant difference was found between CTX group and MMF group in general conditions, base parameters of clinical and pathological findings. The remission rate at the 12th month in CTX and MMF group were 69.6% and 73.1%. The complete remission rate in MMF group (53.8%) was significantly higher than that of the CTX group (26.1%). The relapse rate in MMF group (10.5%) was significantly lower than that of the CTX group (43.8%). 40% of the patients in the CTX group with partial remission relapsed. Two patients in the CTX group and two in the MMF group entered into end stage renal failure (ESRF). The side effect of infection was more significant in the CTX group. Conclusion:Higher complete remission rates and less infection complications were observed in crescentic lupus nephritis patients who received MMF induction regime than in patients who received intravenous pulse cyclophosphamide(CTX) regime.