title: Randomized controlled trial of pulse intravenous cyclophosphamide versus mycophenolate mofetil in the induction therapy of proliferative lupus nephritis.
abstract: BACKGROUND
  The aim of the present study was to evaluate the efficacy of mycophenolate mofetil in the induction therapy of proliferative lupus nephritis.
  
  
  METHODS
  Forty-four patients from eight centres with newly diagnosed lupus nephritis World Health Organization class III or IV were randomly assigned to either mycophenolate mofetil (MMF) 2 g/day for 6 months or intravenous cyclophosphamide (IVC) 0.75-1 g/m(2) monthly for 6 months in addition to corticosteroids.
  
  
  RESULTS
  Remission occurred in 13 out of 25 patients (52%) in the IVC group and 11 out of 19 patients (58%) in the MMF group (P = 0.70). There were 12% in the IVC group and 26% in the MMF group that achieved complete remission (P = 0.22). Improvements in haemoglobin, the erythrocyte sedimentation rate, serum albumin, serum complement, proteinuria, urinary activity, renal function and the Systemic Lupus Erythematosus Disease Activity Index score were similar in both groups. Twenty-four follow-up renal biopsies at the end of therapy showed a significant reduction in the activity score in both groups. The chronicity index increased in both groups but was only significant in the IVC group. Adverse events were similar. Major infections occurred in three patients in each group. There was no difference in gastrointestinal side-effects.
  
  
  CONCLUSIONS
  MMF in combination with corticosteroids is an effective induction therapy for moderately severe proliferative lupus nephritis.
authors.affiliation: Department of Medicine, Penang Hospital, Malaysia.
authors.forename: Loke Meng
authors.initials: LM
authors.lastname: Ong
authors.forename: Lai Seong
authors.initials: LS
authors.lastname: Hooi
authors.forename: Teck Onn
authors.initials: TO
authors.lastname: Lim
authors.forename: Bak Leong
authors.initials: BL
authors.lastname: Goh
authors.forename: Ghazali
authors.initials: G
authors.lastname: Ahmad
authors.forename: Rozina
authors.initials: R
authors.lastname: Ghazalli
authors.forename: Sue Mei
authors.initials: SM
authors.lastname: Teo
authors.forename: Hin Seng
authors.initials: HS
authors.lastname: Wong
authors.forename: Si Yen
authors.initials: SY
authors.lastname: Tan
authors.forename: Wan
authors.initials: W
authors.lastname: Shaariah
authors.forename: Chwee Choon
authors.initials: CC
authors.lastname: Tan
authors.forename: Zaki
authors.initials: Z
authors.lastname: Morad
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D001706:Biopsy; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007275:Injections, Intravenous; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000473:pathology; D008296:Malaysia; D008297:Male; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D020551:Pulse Therapy, Drug; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D009173:Mycophenolic Acid