title: Use of mycophenolate in ANCA-associated renal vasculitis: 13 years of experience at a university hospital.
abstract: BACKGROUND
  Standard therapy with corticosteroids (CS) and cyclophosphamide (CYC) followed by azathioprine has been shown to improve renal and patient survival in ANCA-associated renal vasculitis (rAAV). Mycophenolate mofetil (MF) has been progressively introduced for the treatment of rAAV in the last years because of its immunosuppressive efficacy combined with a lower toxicity profile. In this study, we retrospectively analyse the results of the introduction of MF for maintenance and induction therapy in rAAV in our institution from 2001 to 2013.
  
  
  RESULTS
  We reported 67 patients treated with MF as a maintenance treatment, divided by baseline serum creatinine (>500 µmol/L: Group 1 and <500 µmol/L: Group 2) and treatment schedule. Twenty-nine of the 67 patients were also treated with MF as induction treatment, mostly in Group 2. During the follow-up (2 years after the diagnosis) creatinine levels for serum glomerular filtration rate, ANCA titres, C-reactive protein and percentage of haematuria decreased in all groups. In Group 2, parameters and also relapse rates were similar at 24 months in patients treated with CYC or MF as an induction treatment (Subgroups 2a and 2b, respectively). Median dose of MF in maintenance treatment was 1000 mg daily and prednisone dose was tapered to 10 mg daily from Month 3. After 24 months, 82% of patients remained on MF therapy, 18% had discontinued the treatment, seven of them due to medical indication and two because of gastrointestinal intolerance. The percentage of patients that started renal replacement therapy was irregular in Group 1 depending on the subgroup (25-100%), and 10% in Group 2. Adverse effects, such as neutropenia, infections and neoplasia, were more prevalent in groups treated with CYC.
  
  
  CONCLUSIONS
  In conclusion, in our patients with rAAV, MF demonstrated to be an effective and well-tolerated option for maintenance treatment. As an induction treatment, MF seems to be similar to CYC for patients with moderate renal failure in the diagnosis.
authors: Nephrology Department, Internal Medicine Department, Pathology Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain.
authors: J
authors: J
authors: Draibe
authors: Nephrology Department, Internal Medicine Department, Pathology Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain.
authors: R
authors: R
authors: Poveda
authors: Nephrology Department, Internal Medicine Department, Pathology Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain.
authors: X
authors: X
authors: Fulladosa
authors: Nephrology Department, Internal Medicine Department, Pathology Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain.
authors: A
authors: A
authors: Vidaller
authors: Nephrology Department, Internal Medicine Department, Pathology Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain.
authors: C
authors: C
authors: Zulberti
authors: Nephrology Department, Internal Medicine Department, Pathology Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain.
authors: M
authors: M
authors: Gomà
authors: Nephrology Department, Internal Medicine Department, Pathology Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain.
authors: R
authors: R
authors: Pujol
authors: Nephrology Department, Internal Medicine Department, Pathology Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain.
authors: È
authors: È
authors: Ripoll
authors: Nephrology Department, Internal Medicine Department, Pathology Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain.
authors: J
authors: J
authors: Torras
authors: Nephrology Department, Internal Medicine Department, Pathology Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain.
authors: J M
authors: JM
authors: Grinyó
mesh_terms: D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000150:complications / Q000188:drug therapy*; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood / Q000276:immunology; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005919:Glomerular Filtration Rate; D006785:Hospitals, University; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000188:drug therapy* / Q000209:etiology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D007166:Immunosuppressive Agents; D002097:C-Reactive Protein; D009173:Mycophenolic Acid
keywords: ANCA vasculitis; mycophenolate; renal vasculitis; treatment