A pilot study of mycophenolate mofetil or intravenous cyclophosphamide for type IV lupus nephritis with non-inflammatory necrotizing vasculopathy

Objective:The aim of the present study was to evaluate the efficacy of mycophenolate mofetil(MMF) as the induction therapy on class Ⅳ lupus nephritis(LN) with renal non-inflammatory necrotizing vasculopathy(NNV). Methodology:Twenty patients with class Ⅳ LN combined renal NNV were divided into two groups according to their induction therapy. They were MMF group treated with MMF and cyclophosphamide(CTX) group with intravenous cyclophosphamide (IVC) in addition to corticosteroids. Among them,eight patients were offered MMF 1.5～2.0 g/d for 6 months and nine were treated with IVC 0.75～1 g/m2 monthly for 6 months. The baseline characteristics between the two groups were no significant differences and the efficacy and side effect were compared. Three patients,who were two cases of CTX group and one of MMF group,discontinued in this study. Results:The total remission rate [complete remission(CR) and partial remission(PR)] in MMF group were higher than that in CTX group,CR rate in the 6 month between MMF and CTX group were 37.5% vs 0,P=0.08. MMF as induction therapy was found to be more effective in improvement of the hematuria,proteinuria,and better tolerated with lower adverse reaction rate of severe side effect such as pneumonia and gastrointestinal symptoms. Conclusion:As induction therapy for LN (IV) combined NNV,MMF in combination with corticosteroids is more effective than IVC therapy. Further larger and longer clinical trial ,as well as exploring a optimal therapy,would be required.