A pilot-scale integrated membrane-aerated biofilm reactor (MABR) system, consisted of hydrolysis/acidification pretreatment. MABR process and activated carbon adsorption post-processing, was designed to treat the high-loading mixed pharmaceutical wastewater. A study of MABR process was conducted to investigate the effect of aeration condition, circulation flow rate and water quality on performance over 260 days. The performances of these processes were evaluated by the removal efficiency of COD, BOD5, turbidity, NH4+-N and TN. MABR process could effectively remove above 90% of COD and 98% of ammonia. The capacities per unit volume of MABR could reach up to 1311 gCOD/m(3)d and 48.2 gNH(4)(+)-N/m(3)d with single membrane aeration, and the oxygen utilization rate could be as high as 45%. After post-processing, the effluent of integrated treatment MABR system kept stable with COD below 200 mg/L and NH4+-N below 3 mg/L. (C) 2012 Elsevier Ltd. All rights reserved.