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      Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis.

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          Abstract

          Recent studies have suggested that mycophenolate mofetil (MMF) may offer advantages over intravenous cyclophosphamide (IVC) for the treatment of lupus nephritis, but these therapies have not been compared in an international randomized, controlled trial. Here, we report the comparison of MMF and IVC as induction treatment for active lupus nephritis in a multinational, two-phase (induction and maintenance) study. We randomly assigned 370 patients with classes III through V lupus nephritis to open-label MMF (target dosage 3 g/d) or IVC (0.5 to 1.0 g/m(2) in monthly pulses) in a 24-wk induction study. Both groups received prednisone, tapered from a maximum starting dosage of 60 mg/d. The primary end point was a prespecified decrease in urine protein/creatinine ratio and stabilization or improvement in serum creatinine. Secondary end points included complete renal remission, systemic disease activity and damage, and safety. Overall, we did not detect a significantly different response rate between the two groups: 104 (56.2%) of 185 patients responded to MMF compared with 98 (53.0%) of 185 to IVC. Secondary end points were also similar between treatment groups. There were nine deaths in the MMF group and five in the IVC group. We did not detect significant differences between the MMF and IVC groups with regard to rates of adverse events, serious adverse events, or infections. Although most patients in both treatment groups experienced clinical improvement, the study did not meet its primary objective of showing that MMF was superior to IVC as induction treatment for lupus nephritis.

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          Author and article information

          Journal
          J Am Soc Nephrol
          Journal of the American Society of Nephrology : JASN
          American Society of Nephrology (ASN)
          1533-3450
          1046-6673
          May 2009
          : 20
          : 5
          Affiliations
          [1 ] Department of Nephrology, Columbia University, New York, New York, USA.
          Article
          ASN.2008101028
          10.1681/ASN.2008101028
          2678035
          19369404
          38bdf8e2-fed9-4045-ac6a-609e1becda62
          History

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