***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The presence of renal noninflammatory necrotizing vasculopathy ( NNV ) is often associated with a severe form of lupus nephritis ( LN ) , which is unresponsive to st and ard therapy . We conducted a 6-month r and omized , prospect i ve , open-label trial comparing mycophenolate mofetil ( MMF ) ( 1.5—2.0 g/day ) with monthly i.v . cyclophosphamide ( CTX ) ( 0.75—1.0 g/m2 ) as induction therapy for class IV LN with NNV . The primary and second end points were complete remission ( CR ) and partial remission ( PR ) , respectively . Of 20 patients recruited , nine were r and omly assigned to MMF and 11 to CTX . The baseline characteristics between groups were not significant . CR was achieved in four patients ( 44.4 % ) receiving MMF and in none of the patients receiving CTX ( P = 0.026 ) . PR was achieved in two patients ( 22.2 % ) in the MMF group and three patients ( 27.2 % ) in the CTX group . The total remission rate ( CR + PR ) in the MMF and CTX group was 66.6 and 27.2 % , respectively ( P = 0.17 ) . MMF was more effective than i.v . CTX in reducing proteinuria and haematuria . Adverse events were significantly less frequent with MMF than with CTX ( P = 0.028 ) . MMF was superior to i.v . CTX in inducing CR of LN with NNV and had a more favourable safety profile . Lupus ( 2007 ) 16 , 707—712 For the treatment of proliferative lupus nephritis , long-term cyclophosphamide ( CY ) regimens are efficacious , however , at the expense of substantial toxicity . In the last decade , sequential regimens of short-term CY induction followed by either mycophenolate mofetil ( MMF ) or azathioprine ( AZA ) maintenance have shown to be efficacious and safe reducing the long-term exposure to CY . In a maintenance study including predominantly Hispanics and African-Americans , the patients who received MMF and AZA maintenance  had a higher cumulative probability of remaining free of the composite of death or chronic renal failure ( CRF ) compared to quarterly intravenous CY ( IVCY ) maintenance ( 89 % in MMF , 80 % , in AZA and 45 % in IVCY ) . Likewise , MMF and AZA maintenance were associated with significantly lower incidence of severe infections ( 2 % in each MMF or AZA , and 25 % in IVCY ) , sustained amenorrhea ( 6 % in MMF , 8 % in AZA , and 32 % in IVCY ) , and hospitalizations ( one hospital-days per patient-year in each MMF or AZA , and 10 in IVCY ) . In a European induction study including predominantly Caucasians , patients who received any of two sequential regimens , low dose versus high dose IVCY induction both followed by AZA maintenance , had a high cumulative probability of remaining free of treatment failure ( 84 % in low dose IVCY and 80 % in high dose IVCY ; treatment failure defined as a composite of free of corticosteroid resistant flare , nephrotic syndrome , doubling creatinine , and persistent elevated creatinine ) . Low dose IVCY and high dose IVCY induction were associated with low incidence of sustained amenorrhea ( 4 % in each group ) and severe infections ( 11 % in low dose and 22 % in high dose IVCY induction ) . Of interest , most of the severe infection episodes occurred while patients were receiving IVCY induction . Finally an Asian study demonstrated that patients with proliferative lupus nephritis could be effectively treated with short-term oral CY induction followed by AZA maintenance . The cumulative probability of complete remission was 76 % . The relapse rate was only 11 % . The incidence of permanent amenorrhea and infection were 8 % and 33 % , respectively . None of the Asian patients had an increase in serum creatinine level to double the baseline value . Maintenance therapies with MMF or AZA following short-term CY induction in a sequential regimen are efficacious and safe for the treatment of high-risk patients with proliferative lupus nephritis 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 r and omized , 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 r and omly 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 Patients with lupus membranous nephropathy ( LMN ) are at substantial long-term risk for morbidity and mortality associated with protracted nephrotic syndrome , including ESRD . The optimal treatment for this condition is controversial . Forty-two patients with LMN participated in a r and omized , controlled trial to compare adjunctive immunosuppressive drugs with prednisone alone . Adjunctive regimens included either cyclosporine ( CsA ) for 11 mo or alternate-month intravenous pulse cyclophosphamide ( IVCY ) for six doses ; the control group received alternate-day prednisone alone . Median proteinuria was 5.4 g/d ( range 2.7 to 15.4 g/d ) . We assessed the primary outcome , time to remission of proteinuria during the 12-mo protocol , by univariate survival analysis . At 1 yr , the cumulative probability of remission was 27 % with prednisone , 60 % with IVCY , and 83 % with CsA. Although both IVCY and CsA were more effective than prednisone in inducing remissions of proteinuria , relapse of nephrotic syndrome occurred significantly more often after completion of CsA than after IVCY . By multivariate survival analysis , treatment with prednisone and high- grade proteinuria ( > 5 g/d ) but not race or ethnicity were independently associated with a decreased probability of remission . Adverse effects during the 12-mo protocol included insulin-requiring diabetes ( one with prednisone and two with CsA ) , pneumonia ( one with prednisone and two with CsA ) , and localized herpes zoster ( two with IVCY ) . In conclusion , regimens containing CsA or IVCY are each more effective than prednisone alone in inducing remission of proteinuria among patients with LMN OBJECTIVE To compare the efficacy and side effects of intermittent pulse cyclophosphamide plus methylprednisolone with continuous oral cyclophosphamide plus prednisolone , followed by azathioprine , in patients with proliferative glomerulonephritis caused by systemic lupus erythematosus ( SLE ) . METHODS A multicentre r and omised controlled trial was conducted between June 1992 and May 1996 involving eight European centres . All patients satisfied the American College of Rheumatology criteria for SLE and had biopsy proven proliferative lupus nephritis . All received corticosteroids in addition to cytotoxic drugs , as defined in the protocol , for two years . The trial was terminated after four years as recruitment was disappointing . RESULTS 32 SLE patients with lupus nephritis were recruited : 16 were r and omised to intermittent pulse cyclophosphamide and 16 to continuous cyclophosphamide plus azathioprine .  Mean duration of follow up was 3.7 years in the continuous group ( range 0 to 5.6 ) and 3.3 years in the pulse group ( range 0.25 to 6 ) . Three patients were excluded from the pulse therapy group as they were later found to have pure mesangial glomerulonephritis . Two patients in the continuous therapy group developed end stage renal failure requiring dialysis , but none in the intermittent pulse therapy ( p = 0.488 ; NS ) . There were similar numbers of side effects and withdrawals from treatment in both groups . There were three deaths : two in the intermittent pulse therapy group and one in the continuous therapy group . CONCLUSIONS There was no statistically significant difference in efficacy and side effects between the two regimens . Infectious complications occurred commonly , so careful monitoring is required during treatment BACKGROUND The aim of the present study was to evaluate the efficacy of mycophenolate mofetil in the induction therapy of proliferative lupus nephritis . METHODS Forty-four patients from eight centres with newly diagnosed lupus nephritis World Health Organization class III or IV were r and omly assigned to either mycophenolate mofetil ( MMF ) 2 g/day for 6 months or intravenous cyclophosphamide ( IVC ) 0.75 - 1 g/m(2 ) monthly for 6 months in addition to corticosteroids . RESULTS Remission occurred in 13 out of 25 patients ( 52 % ) in the IVC group and 11 out of 19 patients ( 58 % ) in the MMF group ( P = 0.70 ) . There were 12 % in the IVC group and 26 % in the MMF group that achieved complete remission ( P = 0.22 ) . Improvements in haemoglobin , the erythrocyte sedimentation rate , serum albumin , serum complement , proteinuria , urinary activity , renal function and the Systemic Lupus Erythematosus Disease Activity Index score were similar in both groups . Twenty-four follow-up renal biopsies at the end of therapy showed a significant reduction in the activity score in both groups . The chronicity index increased in both groups but was only significant in the IVC group . Adverse events were similar . Major infections occurred in three patients in each group . There was no difference in gastrointestinal side-effects . CONCLUSIONS MMF in combination with corticosteroids is an effective induction therapy for moderately severe proliferative lupus nephritis OBJECTIVE In the Euro-Lupus Nephritis Trial ( ELNT ) , 90 patients with lupus nephritis were r and omly assigned to a high-dose intravenous cyclophosphamide ( IV CYC ) regimen ( 6 monthly pulses and 2 quarterly pulses with escalating doses ) or a low-dose IV CYC regimen ( 6 pulses of 500 mg given at intervals of 2 weeks ) , each of which was followed by azathioprine ( AZA ) . After a median followup of 41 months , a difference in efficacy between the 2 regimens was not observed . The present analysis was undertaken to extend the followup and to identify prognostic factors . METHODS Renal function was prospect ively assessed quarterly in all 90 patients except 5 who were lost to followup .  Survival curves were derived using the Kaplan-Meier method . RESULTS After a median followup of 73 months , there was no significant difference in the cumulative probability of end-stage renal disease or doubling of the serum creatinine level in patients who received the low-dose IV CYC regimen versus those who received the high-dose regimen . At long-term followup , 18 patients ( 8 receiving low-dose and 10 receiving high-dose treatment ) had developed permanent renal impairment and were classified as having poor long-term renal outcome . We demonstrated by multivariate analysis that early response to therapy at 6 months ( defined as a decrease in serum creatinine level and proteinuria < 1 g/24 hours ) was the best predictor of good long-term renal outcome . CONCLUSION Long-term followup of patients from the ELNT confirms that , in lupus nephritis , a remission-inducing regimen of low-dose IV CYC followed by AZA achieves clinical results comparable with those obtained with a high-dose regimen . Early response to therapy is predictive of good long-term renal outcome OBJECTIVE Glomerulonephritis is a severe manifestation of systemic lupus erythematosus ( SLE ) that is usually treated with an extended course of intravenous ( IV ) cyclophosphamide ( CYC ) . Given the side effects of this regimen , we evaluated the efficacy and the toxicity of a course of low-dose IV CYC prescribed as a remission-inducing treatment , followed by azathioprine 
    Output:
    
In terms of induction therapies , MMF did not increase complete remission or partial remission rates as compared with CYC .
However , the relative risks ( RRs ) of amenorrhea and leukopenia tended to be lower in the MMF group than in the CYC group .
Meta- analysis of MMF versus AZA as a maintenance therapy showed no difference between the two groups in terms of response rates or the risk of developing end-stage renal disease .
In conclusion , MMF was found to be as effective as CYC and tended to have a better safety profile as an induction therapy for LN than CYC