Tolerance of mycophenolate mofetil in end-stage renal disease patients with ANCA-associated vasculitis.
BACKGROUND
Mycophenolate mofetil (MMF) has been used successfully in patients with ANCA-associated vasculitis as maintenance therapy. Only transient and moderate side effects have been reported with a daily dose of 2 g. Since all the treated patients who have been reported so far had no or only moderate renal insufficiency when MMF was initiated, no data are available regarding side effects in patients with end-stage renal disease (ESRD).


METHODS
Five ESRD patients with ANCA-associated vasculitis and a relapsing course of their disease were treated. All patients had pretreatment with cyclophosphamide for at least 17 months. MMF was initiated as a remission maintenance therapy, and started with a dose of 1 g/d. The aim was to increase the MMF dose to 2 g/d. Blood counts, liver enzymes and gastrointestinal side effects were monitored.


RESULTS
Four patients developed severe anemia, 2 requiring blood transfusion with permanent or temporary cessation of MMF treatment. One patient developed leukopenia. Gastrointestinal symptoms led to a dose reduction to 1 g/d (n = 2) or cessation of treatment (n = 1). Three patients remained on longer MMF treatment; however, their daily dose did not exceed 1 g.


CONCLUSIONS
MMF, a promising drug regarding maintenance therapy in ANCA-associated vasculitis, seems to have more side effects in ESRD patients, leading to dose reduction or even cessation of treatment. Therefore, in this patient group a lower dose and closer monitoring for side effects seems to be required compared to patients with no or moderate renal insufficiency.
Haubitz
M
M
Department of Nephrology, University Hospital Hannover, Germany. Familie.Haubitz@t-online.de
de Groot
K
K
D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000139:chemically induced* / Q000150:complications; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives / Q000627:therapeutic use*; D012008:Recurrence; D013997:Time Factors; D014657:Vasculitis / Q000150:complications / Q000188:drug therapy* / Q000209:etiology*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D019268:Antibodies, Antineutrophil Cytoplasmic; D009173:Mycophenolic Acid