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ACR: Mycophenolate Mofetil May Be Inferior to Azathioprine

Less likely to prevent relapse in antineutrophil cytoplasmic antibody-associated vasculitis

TUESDAY, Nov. 9 (HealthDay News) -- Mycophenolate mofetil appears to be less effective than azathioprine for maintaining disease remission among patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV), according to a study published online Nov. 8 in the Journal of the American Medical Association to coincide with presentation at the annual meeting of the American College of Rheumatology, held from Nov. 7 to 11 in Atlanta.

Thomas F. Hiemstra, M.D., of the Cambridge University Hospitals NHS Foundation Trust in the United Kingdom, and colleagues randomized 156 patients with AAV to azathioprine (starting at 2 mg/kg/d) or mycophenolate mofetil (starting at 2,000 mg/d) after remission was induced with cyclophosphamide and prednisolone.

Over a median follow-up of 39 months, the investigators found that relapses were more common among patients in the mycophenolate mofetil group than among those in the azathioprine group (unadjusted hazard ratio, 1.69). Severe adverse events did not differ significantly between the mycophenolate mofetil and azathioprine groups. Outcome measures, including Vasculitis Damage Index, estimated glomerular filtration rate, and proteinuria, did not differ significantly between the two groups.

"Contrary to the hypothesis that mycophenolate mofetil is more efficacious than azathioprine without compromising patient safety, we have shown that mycophenolate mofetil is less effective than azathioprine for the prevention of relapses in AAV," the authors write. "Although mycophenolate mofetil may be considered in refractory cases, it should not be considered the first-line remission maintenance therapy in AAV."

Several authors disclosed financial ties to pharmaceutical companies, including Hoffman-La Roche, which provided reimbursement for study drugs.

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