FRI0190 COMPARATIVE EFFICACY AND SAFETY OF MYCOPHENOLATE MOFETIL VERSUS CYCLOPHOSPHAMIDE IN PATIENTS WITH ACTIVE ANTINEUTROPHIL CYTOPLASMIC ANTIBODY-ASSOCIATED VASCULITIS: A META-ANALYSIS OF RANDOMIZED TRIALS
Authors: Y. H. Lee, G. G. Song
Journal: Annals of the Rheumatic Diseases (2020)

Background: Cyclophosphamide (CYC) is effective for induction of remission of AAV, resulting in complete remission rates of around 70%. Thus, CYC has been the standard remission induction therapy for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV); however, it is toxic and causes infections, malignancies, and infertility. Therefore, other agents that are less toxic but that have similar efficacy were explored. Since the disease course of AAV usually requires long-term immunosuppression, mycophenolate mofetil (MMF), a less toxic agent compared to CYC, has been explored as an alternative to CYC. Objectives: The aim of this study is to assess the efficacy and safety of MMF versus cyclophosphamide CYC in patients with active AAV. Methods: We performed a meta-analysis of four randomized clinical trials (RCTs) (300 patients) to examine the relative efficacy and safety of MMF compared to CYC in patients with active AAV. Results: There was no significant difference in remission at 6 months between MMF and CYC (OR 1.311, 95% confidence interval [CI] 0.570 – 3.017, P = 0.524). Additionally, the relapse rate did not differ between the MMF group and CYC group (OR 1.331, 95% CI 0.497 – 3.568, P = 0.570). There was no significant difference in serious adverse event (SAE) (OR 1.232, 95% CI 0.754 – 2.014, P = 0.404) and infection rate (OR 0.958, 95% CI 0.561 – 1.634, P = 0.873) between the MMF and CYC groups. Some heterogeneity was found in the meta-analysis of remission and relapse rate ( I 2 = 57.4%, 63.4%), but no between-study heterogeneity was found during the meta-analysis of the SAE and infection rate. Egger’s regression test showed no evidence of publication bias (Egger’s regression test P -values &gt; 0.1). Conclusion: MMF was an equally effective alternative treatment to CYC, and MMF was comparable to CYC in patients with active AAV in terms of safety, suggesting that MMF can be used as an alternative to CYC for remission induction in AAV. References: [1]Han F, Liu G, Zhang X, Li X, He Q, He X, Li Q, Wang S, Wang H, Chen J (2011) Effects of mycophenolate mofetil combined with corticosteroids for induction therapy of microscopic polyangiitis. Am J Nephrol 33:185-192 [2]Jones RB, Hiemstra TF, Ballarin J et al (2019) Mycophenolate mofetil versus cyclophosphamide for remission induction in ANCA-associated vasculitis: a randomised, non-inferiority trial. Ann Rheum Dis 78:399-405 [3]Tuin J, Stassen PM, Bogdan DI, Broekroelofs J, van Paassen P, Cohen Tervaert JW, Sanders JS, Stegeman CA (2019) Mycophenolate Mofetil Versus Cyclophosphamide for the Induction of Remission in Nonlife-Threatening Relapses of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: Randomized, Controlled Trial. Clin J Am Soc Nephrol 14:1021-1028 [4]Hu W, Liu C, Xie H, Chen H, Liu Z, Li L (2008) Mycophenolate mofetil versus cyclophosphamide for inducing remission of ANCA vasculitis with moderate renal involvement. Nephrol Dial Transplant 23:1307-1312 Disclosure of Interests: None declared