Efficacy of mycophenolate mofetil as a remission induction therapy in antineutrophil cytoplasmic antibody: associated vasculitis-a meta-analysis.
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
/ drug therapy
Cyclophosphamide
/ adverse effects
Humans
Immunosuppressive Agents
/ adverse effects
Leukopenia
/ chemically induced
Mycophenolic Acid
/ adverse effects
Randomized Controlled Trials as Topic
Recurrence
Remission Induction
/ methods
Treatment Outcome
ANCA-associated vasculitis
cyclophosphamide
meta-analysis
mycophenolate mofetil
randomised control trials
Journal
RMD open
ISSN: 2056-5933
Titre abrégé: RMD Open
Pays: England
ID NLM: 101662038
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
received:
28
01
2020
revised:
25
03
2020
accepted:
29
03
2020
entrez:
7
5
2020
pubmed:
7
5
2020
medline:
20
4
2021
Statut:
ppublish
Résumé
A few studies on antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) treatments have shown the therapeutic efficacy of mycophenolate mofetil (MMF). However, the therapeutic efficacy of MMF compared with that of cyclophosphamide (CYC) in patients with AAV has not been established. We conducted a systematic review and meta-analysis to assess the efficacy of MMF as a remission induction therapy in patients with AAV comparing it with the efficacy of CYC. We searched randomised controlled trials (RCTs) comparing the efficacy of MMF with that of CYC in patients with AAV on three different websites: PubMed, Cochrane Library and Google Scholar. We compared the difference in the relative risk (RR) of each outcome based on a Mantel-Haenszel random-effects model. We analysed data from four RCTs with 300 patients for the study. The 6-month remission rate (RR 1.09, 95% CI 0.86 to 1.38, p=0.48), the 6-month ANCA negativity (RR 1.31, 95% CI 0.91 to 1.90, p=0.15) and the long-term relapse rate (RR 1.36, 95% CI 0.80 to 2.31, p=0.26) were all similar between the two treatments. The rates of death, infection and leucopenia were also similar between the two groups (RR 1.05, 95% CI 0.40 to 2.74, p=0.93; RR 1.26, 95% CI 0.79 to 2.01, p=0.33; RR 0.45, 95% CI 0.16 to 1.32, p=0.15, respectively). We found no difference between the therapeutic efficacy of MMF and that of CYC in patients with AAV. MMF may be an alternative remission induction therapy in patients with non-life-threatening AAV.
Identifiants
pubmed: 32371435
pii: rmdopen-2020-001195
doi: 10.1136/rmdopen-2020-001195
pmc: PMC7299518
pii:
doi:
Substances chimiques
Immunosuppressive Agents
0
Cyclophosphamide
8N3DW7272P
Mycophenolic Acid
HU9DX48N0T
Types de publication
Comparative Study
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Stat Med. 2002 Jun 15;21(11):1539-58
pubmed: 12111919
Drugs. 1996 Feb;51(2):278-98
pubmed: 8808168
Contemp Clin Trials. 2007 Feb;28(2):105-14
pubmed: 16807131
Ann Intern Med. 2009 May 19;150(10):670-80
pubmed: 19451574
Arthritis Rheum. 2013 Jan;65(1):206-10
pubmed: 23044647
Ann Rheum Dis. 2019 Jun;78(6):736-745
pubmed: 30926722
Am J Ophthalmol. 2008 Dec;146(6):802-12.e1
pubmed: 18579112
Medicine (Baltimore). 1973 Nov;52(6):535-61
pubmed: 4748591
Clin J Am Soc Nephrol. 2010 Mar;5(3):445-53
pubmed: 20093349
Ann Rheum Dis. 2019 Mar;78(3):399-405
pubmed: 30612116
BMJ. 2019 Aug 28;366:l4898
pubmed: 31462531
Arthritis Rheum. 2012 Oct;64(10):3452-62
pubmed: 23023777
N Engl J Med. 1971 Apr 29;284(17):938-42
pubmed: 5551803
Ann Rheum Dis. 2016 Sep;75(9):1583-94
pubmed: 27338776
Clin J Am Soc Nephrol. 2007 Sep;2(5):968-75
pubmed: 17702723
Arthritis Rheum. 2013 Jan;65(1):1-11
pubmed: 23045170
Nephrol Dial Transplant. 2008 Nov;23(11):3514-20
pubmed: 18586766
Arthritis Care Res (Hoboken). 2011 Dec;63(12):1777-81
pubmed: 22127969
Arthritis Rheum. 1994 Feb;37(2):187-92
pubmed: 8129773
Nephrol Dial Transplant. 2005 Dec;20(12):2725-32
pubmed: 16188901
Am J Nephrol. 2011;33(2):185-92
pubmed: 21311184
Rheumatology (Oxford). 2014 Mar;53(3):532-9
pubmed: 24282319
J Rheumatol. 2011 Jan;38(1):69-78
pubmed: 20952473
Ann Rheum Dis. 2007 Jun;66(6):798-802
pubmed: 17179175
PLoS Med. 2018 Nov 1;15(11):e1002685
pubmed: 30383787
Lupus. 2005;14 Suppl 1:s2-8
pubmed: 15803924
Arthritis Res Ther. 2017 Jun 7;19(1):129
pubmed: 28592297
Clin Pharmacol Ther. 2005 Oct;78(4):317-21
pubmed: 16198650
Autoimmunity. 2014 Sep;47(6):401-8
pubmed: 24798501
Bone Marrow Transplant. 2013 Mar;48(3):452-8
pubmed: 23208313
Syst Rev. 2015 Jan 01;4:1
pubmed: 25554246
N Engl J Med. 2010 Jul 15;363(3):211-20
pubmed: 20647198
Nephron Clin Pract. 2006;102(3-4):c100-7
pubmed: 16286784
Clin J Am Soc Nephrol. 2019 Jul 5;14(7):1021-1028
pubmed: 31253599
Clin Exp Nephrol. 2013 Oct;17(5):607-610
pubmed: 23843034
J Rheumatol. 2020 Mar;47(3):407-414
pubmed: 31203229
N Engl J Med. 2010 Jul 15;363(3):221-32
pubmed: 20647199
BMJ. 2003 Sep 6;327(7414):557-60
pubmed: 12958120