***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 OBJECTIVE To investigate the efficacy and safety of ocrelizumab in patients with class III/IV lupus nephritis ( LN ) . METHODS Patients were r and omized 1:1:1 to receive placebo , 400 mg ocrelizumab , or 1,000 mg ocrelizumab given as an intravenous infusion on days 1 and 15 , followed by a single infusion at week 16 and every 16 weeks thereafter , accompanied by background glucocorticoids plus either mycophenolate mofetil ( MMF ) or the Euro-Lupus Nephritis Trial ( ELNT ) regimen ( cyclophosphamide followed by azathioprine ) . The study was terminated early due to an imbalance in serious infections in  ocrelizumab-treated patients versus  placebo-treated patients . We report week 48 efficacy data for patients receiving ≥32 weeks of treatment ( n = 223 ) and safety results for all treated patients ( n = 378 ) . RESULTS The overall renal response rate was 54.7 % , 66.7 % , 67.1 % , and 66.9 % in the placebo-treated , 400 mg ocrelizumab-treated , 1,000 mg ocrelizumab-treated , and combined ocrelizumab-treated groups , respectively . The associated treatment difference versus placebo for the combined ocrelizumab-treated groups was 12.7 % ( 95 % confidence interval [ 95 % CI ] -0.8 , 26.1 ) ( P = 0.065 ) , with similar differences observed for both ocrelizumab-treated groups . Ocrelizumab versus placebo treatment differences were apparent in patients receiving the background ELNT regimen , but not in those receiving background MMF . A numerically greater proportion of ocrelizumab-treated patients had a ≥50 % reduction in the urinary protein : urinary creatinine ratio at 48 weeks compared with placebo-treated patients ( placebo-treated patients , 58.7 % ; 400 mg ocrelizumab-treated patients , 70.7 % ; 1,000 mg ocrelizumab-treated patients , 68.5 % ) . Serious adverse events occurred in 27.2 % of placebo-treated patients , 35.7 % of 400 mg ocrelizumab-treated patients , and 22.0 % of 1,000 mg ocrelizumab-treated patients . Corresponding serious infection rates ( events/100 patient-years ) were 18.7 ( 95 % CI 12.2 , 28.7 ) , 28.8 ( 95 % CI 20.6 , 40.3 ) , and 25.1 ( 95 % CI 17.4 , 36.1 ) , respectively . The imbalance in serious infections with ocrelizumab occurred with background MMF but not with the background ELNT regimen . CONCLUSION In patients with active LN , overall renal response rates with ocrelizumab were numerically but not statistically significantly superior to those with placebo . Ocrelizumab treatment was associated with a higher rate of serious infections in the subgroup receiving background MMF Controlled clinical trials in renal transplantation have demonstrated that mycophenolate mofetil is well tolerated and has lower renal transplant rejection rates than azathioprine regimens . This study reports on the clinical experiences at two institutions with  mycophenolate mofetil ( MMF ) for severe lupus nephritis . Twelve patients with relapsing or resistant nephritis previously treated with cyclophosphamide therapy and one patient who refused cyclophosphamide as initial therapy for diffuse proliferative nephritis but accepted MMF were included . During combined MMF/prednisone therapy , serum creatinine values remained normal or declined from elevated values : mean change in serum creatinine was -0.26+/-0.46 microM/L , P = 0.039 . Proteinuria significantly decreased : mean change in urine protein-to-creatinine ratios was -2.53+/-3.76 , P = 0.039 . Decreased serum complement component C3 and elevated anti-double-str and ed DNA antibody levels at baseline improved in some , but not all , patients . The mean initial dose of  MMF  was 0.92 g/d ( range , 0.5 to 2 g/d ) . The mean duration of therapy was 12.9 mo ( range , 3 to 24 mo ) . Adverse events included herpes simplex stomatitis associated with severe leukopenia ( n = 1 ) , asymptomatic leukopenia ( n = 2 ) , nausea/ diarrhea ( n = 2 ) , thinning of scalp hair ( n = 1 ) , pancreatitis ( n = 1 ) , and pneumonia without leukopenia ( n = 1 ) . Recurrence of the pancreatitis led to discontinuation of MMF in this patient ; all other adverse events resolved with dose reduction . It is concluded that MMF is well tolerated and has possible efficacy in controlling major renal manifestations of systemic lupus erythematosus . Controlled clinical trials are needed to define the role of MMF in the management of lupus nephritis BACKGROUND The therapy of severe lupus nephritis ( LN ) consists of high-dose steroids and immunosuppressive agents , usually cyclophosphamide . Although effective in up to 90 % of cases , this approach leads to undesirable complications in many cases . In recent years , mycophenolate mofetil ( MMF ) , an immunosuppressive drug used in transplantation regimes , seems to be effective in selected cases of lupus nephritis . METHODS In this report we present the results using MMF in seven cases of LN .  MMF stabilized renal function , controlled extrarenal disease activity and led to less steroid dosing . RESULTS Three patients achieved complete remission , two partial remissions and two failed , although these two patients were the ones with the highest chronicity indices in the renal biopsies . However , they were able to maintain stable renal function for more than one year with tolerable side effects . In two more patients the latter were mild and did not require either hospitalization or intense therapy . CONCLUSIONS MMF can be an option for selected cases with severe relapsing or persistent LN and can lead to induction of remission . This observation needs to be exp and ed . Larger r and omized controlled studies are needed to evaluate its indication in earlier cases as induction of de novo disease and /or effective remission maintenance Pulse cyclophosphamide is more effective than prednisone alone in preventing  renal failure in lupus nephritis . We undertook a r and omised , controlled trial to find out whether pulse methylprednisolone could equal pulse cyclophosphamide in preserving renal function in patients with lupus nephritis , and whether there was a difference between long and short courses of pulse cyclophosphamide in preventing exacerbations . 65 patients ( 60 female , 5 male ; median [ range ] age 29 [ 10 - 48 ] years ) with severe lupus nephritis were assigned r and omly to monthly pulse methylprednisolone for 6 months ( 25 patients ) , monthly pulse cyclophosphamide for 6 months ( 20 ) , or monthly cyclophosphamide for 6 months followed by quarterly pulse cyclophosphamide for 2 additional years ( 20 ) . Patients treated with pulse methylprednisolone had a higher probability of doubling serum creatinine than those treated with long-course cyclophosphamide ( p less than 0.04 ) . Risk of doubling creatinine was not significantly different between short and long course cyclophosphamide . However , patients treated with short-course cyclophosphamide had a higher probability of exacerbations than those treated with long-course cyclophosphamide ( p less than 0.01 ) . An extended course of pulse cyclophosphamide is more effective than 6 months of pulse methylprednisolone in preserving renal function in patients with severe lupus nephritis . Addition of a quarterly maintenance regimen to monthly pulse cyclophosphamide reduces the rate of exacerbations 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 Debate continues about the optimal treatment modality of lupus nephritis ( LN ) . We compared the efficacy and safety of intravenous cyclophosphamide ( CYC ) and mycophenolate mofetil ( MMF ) for LN treatment in Korea . After search ing for systemic lupus erythematosus ( SLE ) patients diagnosed between 1998 and 2007 with the diagnostic code of ICD10 , we selected the 71 patients who were treated with CYC or MMF without any other immunosuppressant except systemic steroid .  Composite outcome was defined as progression to end-stage renal disease ( ESRD ) and /or all-cause mortality . The initial manifestations of the CYC group were more severe than those of the MMF group . The mean daily MMF dose was 980 ± 100 mg for 21.67 ± 18.25 months . The mean monthly dose per CYC pulse therapy was 850 ± 30 mg for 17.04 ± 13.15 months . The incidence of composite outcome was 5/20 ( 25 % ) in the MMF group and 4/51 ( 7.8 % ) in the CYC group . The relative risk ( RR ) for composite outcome in the CYC group was 0.249 ( 95 % CI for RR : 0.067–0.934 , p = 0.039 ) compared with the MMF group with Cox 's hazard proportional analysis . In Kaplan – Meier analysis , the probability of composite outcome was lower in the CYC group than in the MMF group ( Log rank test p-value = 0.026 ) . The results of this retrospective study suggest that intravenous CYC therapy may be more efficacious in averting ESRD and death  than MMF . These results need to be confirmed in a larger r and omized controlled trial We retrospectively studied the evolution of histopathologic features in successive renal biopsies in patients with lup 
    Output:
    
The pooled results suggest that mycophenolate mofetil and cyclophosphamide are equally effective in inducing remission of severe lupus nephritis .
However , relapse rates and risk of developing ESRD were higher for mycophenolate mofetil compared with cyclophosphamide .
In conclusion , in the short term , mycophenolate mofetil and cyclophosphamide are about equal in inducing remission .
However , long-term outcomes suggest better preservation of kidney function and fewer relapses with cyclophosphamide therapy .
Therefore , mycophenolate mofetil should not yet be considered the induction drug of choice for severe lupus nephritis