Effects of mycophenolate mofetil on patients with pauci-immune crescentic glomerulonephritis.

Objective To compare the effect,relapse rate and outcomes between mycophenolate mofetil(MMF)and pulse intravenous cyclophosphamide(CTX)in the induction therapy of pauci-immune crescentic glomerulonephritis(PICGN)in Chinese.Methods A total of 44 patients who had PICGN[16 male,28 female,age(46.8±13.7)y],of whom 25 patients were ANCA positive,were enrolled in this study.All patients had renal involvement with ≥50% crescent formation prior to the study and received either MMF treatment(MMF group,n=22)or intermittent CTX pulse therapy(CTX group,n=22).The patients in both groups also received methylprednisolone(MP)pulse therapy followed by oral prednisone.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 of 8～60(Med 27)months in the MMF group,and 6～72(Med 29)months in the CTX group.Results No significant difference was found between MMF group and CTX group in general conditions,base parameters of clinical and pathological findings.The remission rate at the 12th month in MMF and CTX group was 90.9% and 72.7% respectively.The complete remission rate in MMF group(59.1%)was significantly higher than that of the CTX group(27.3%)(P0.05).Furthermore,3 of the 13 ANCA positive patients(23.7%)in the MMF group and none of the 12 patients in the CTX group were ANCA negative after 12 months' treatment.The relapse rate in MMF group(4.5%)was lower than that of the CTX group(23.5%).Four patients(18.2%)in the CTX group and 1(4.5%)in the MMF group entered into end stage renal failure(ESRF)during the follow-up.Two patients died in each group.However,the side effect of infection was more significant in the MMF group(22.7%)than in the CTX group(4.5%).Conclusion MMF is more effective than intermittent CTX pulse therapy in inducing remission,improving renal function and reducing relapse rate in patients with PICGN,although potentially associated with a higher infection rate.