Mycophenolate mofetil in anti-MPO renal vasculitis: an alternative therapy in case of cyclophosphamide or azathioprine toxicity.
BACKGROUND
Standard therapy with corticosteroids and cyclophosphamide followed by azathioprine has improved renal and patient survival in renal vasculitis. However, this regimen is associated with high toxicity. Mycophenolate mofetil (MMF), a less toxic immunosuppressive drug, has been proposed as a therapeutic alternative.


METHODS
We report 12 patients (4 males, 8 females, aged 65.6 A+/- 12.1 years) with anti-MPO renal vasculitis who were switched from standard therapy to MMF because of drug-related adverse effects: leukopenia, toxic hepatitis, nausea, hair loss or appearance of carcinoma. MMF was introduced at a dose of 500 mg/8 h, after 83 A+/- 56 days under standard therapy.


RESULTS
After 354 A+/- 195 days of MMF therapy, all patients maintained clinical remission. Mean values of serum anti-MPO, disease activity markers and serum creatinine decreased when these values were compared from pre-therapy to the time of switching to MMF, and then to the end of the study anti-MPO: 204 A+/- 144 U, 54 A+/- 85 U and 12 A+/- 5 U. Serum-reactive C protein 97 A+/- 82 mg/l, 13 A+/- 10 mg/l and 4 A+/- 2 mg/l. Erythrocyte sedimentation rate 88 A+/- 40, 41 A+/- 28 and 26 A+/- 15 mm. Serum creatinine 415 A+/- 238, 202 A+/- 93 and 169 A+/- 104 micromol/l. In one case there was a relapse of vasculitis under MMF and a low dose of prednisone after 9 months of therapy. Side effects were herpes infection in four cases and chickenpox in one. Neither leukopenia nor anemia was observed.


CONCLUSIONS
These results indicate that MMF could be an alternative therapy for anti-MPO renal vasculitis associated with cyclophosphamide or azathioprine-related toxicity.
Department of Nephrology, Hospital Universitari de Bellvitge, Barcelona, Spain.
M
M
Ibernon
R
R
Poveda
A
A
Vidaller
O
O
Bestard
J M
JM
Grinyó
D000368:Aged; D001323:Autoantibodies; D001379:Azathioprine / Q000009:adverse effects; D003520:Cyclophosphamide / Q000009:adverse effects; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009195:Peroxidase / Q000276:immunology; D014657:Vasculitis / Q000188:drug therapy* / Q000276:immunology
D001323:Autoantibodies; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D009195:Peroxidase; D009173:Mycophenolic Acid; D001379:Azathioprine