Efficacy and safety of 'rescue therapy' with mycophenolate mofetil in resistant primary glomerulonephritis--A multicenter study

Segarra, Alfons; Amoedo, Maria Luisa; Garcia, Jose M Martinez; Pons, S; Praga, Manuel; Garcia, Elvira Izquierdo; Alonso, Juan Carlos Gómez; Gascó, J; Pou, Leonor; Piera, L

doi:10.1093/ndt/gfl805

Cited by 26 publications

(8 citation statements)

References 23 publications

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“…This is not in agreement with recent observation from Segarra et al [23], who found that probability of remission (complete or partial) was not associated with age, gender, type of GN or time from diagnosis. They determined that higher GFR and basal nephritic proteinuria were associated with higher reduction of proteinuria [23]. …”

Section: Discussioncontrasting

confidence: 92%

Mycophenolate Mofetil in High-Risk Patients with Primary Glomerulonephritis: Results of a 1-Year Prospective Study

et al. 2009

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Background/Aims: Glucocorticoids and classic immunosuppressive drugs can improve disease activity in primary glomerulonephritis (GN). However, these drugs have serious toxicity and patients frequently experience inadequate response or relapse, so there is a need for alternative agents. This multicenter uncontrolled study analyzed the efficacy and safety of mycophenolate mofetil (MMF) in high-risk patients with primary GN. Methods: A total of 51 patients with biopsy-proven membranous (n = 12), membranoproliferative (n = 15), mesangioproliferative (n = 10), focal segmental glomerulosclerosis (n = 13) and minimal change disease (n = 1) received MMF with low-dose corticosteroids for 1 year. The primary outcome included the number of patients with complete/partial remission. Results: Proteinuria significantly decreased, from its median value of 4.9 g/day (IQR 2.9–8.4) to 1.28 g/day (IQR 0.5–2.9), p < 0.001. The urine protein/creatinine ratio significantly improved, from a median of 3.72 (IQR 2.13–6.48) to 0.84 (IQR 0.42–2.01), p < 0.001. The mean area under the curve for proteinuria significantly decreased, from 4.99 ± 3.46 to 2.16 ± 2.46, between the first (visits 1–2) and last (vists 4–5) treatment periods (p < 0.001). The change was similar for every type of GN, without difference between groups. eGFR slightly increased (62.1 ± 31.8 to 65.3 ± 31.8 ml/min, p = n.s.) and ESR, total proteins, albumins, total- and HDL-cholesterol parameters improved significantly. Systolic, diastolic and mean blood pressure decreased (p < 0.02 for systolic blood pressure). The age of patients was the only independent predictor of complete or partial remission. Conclusion: MMF proved to be efficient in 70% of high-risk patients with primary GN, who reached either complete or partial remission without safety concern after 12 months of treatment. Favorable effects of MMF therapy have to be confirmed in the long term and particularly after discontinuation of the drug.

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Section: Discussioncontrasting

confidence: 92%

Mycophenolate Mofetil in High-Risk Patients with Primary Glomerulonephritis: Results of a 1-Year Prospective Study

et al. 2009

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“…In a study with adult patients, Dimkovic et al found that more advanced age was the only predictor of favorable response to MMF [23], whereas Segarra et al [24], similar to the results reported here, did not confirm that finding. However, our study was performed with pediatric patients.…”

Section: Discussionsupporting

confidence: 46%

Mycophenolate mofetil in children with steroid/cyclophosphamide-resistant nephrotic syndrome

Mello¹,

Rodrigues²,

Mastrocinque³

et al. 2009

Pediatr Nephrol

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The purpose of this study was to assess the results of therapy with mycophenolate mofetil (MMF) in children with idiopathic nephrotic syndrome (INS) who were both steroid- and cyclophosphamide-resistant. Treatment lasted a minimum of 6 months, and follow-up data were collected over a 2-year period. The children were divided into two groups: Group 1 (n=34) comprised patients who had received cyclosporine A (CsA) before the initiation of MMF therapy; Group 2 (n=18) comprised patients who received only MMF. Among the 34 patients of Group 1, complete and partial remission were achieved in seven (20.6%) and 13 patients (38.6%), respectively; there was no response in 14 patients (41.2%). Among the 18 patients in Group 2, complete and partial remission occurred in five (27.8%) and six (33.3%) patients, respectively; there was no response in seven patients (38.9%). Eight patients developed chronic kidney disease. The main side-effects were gastrointestinal complaints (n=11, 21%), recurring severe infections (n=1, 1.9%), and mild thrombocytopenia/leucopenia (n=1, 1.9%). MMF proved to be therapeutically effective in 59.5% of the cases. These beneficial effects need to be confirmed in studies with a long-term follow-up after discontinuation of the treatment. Our statistical analysis of the results of therapy with MMF did not reveal any significant difference between its use alone or following CsA administration.

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“…1,2 Treatment with several immunosuppressive agents has shown beneficial effect on the course of this disease [3][4][5][6][7][8][9][10][11] ; however, controversy persists regarding the proper timing of immunosuppression and the best therapeutic regimen. [12][13][14][15] The appearance of spontaneous remission (SR) in IMN not induced by immunosuppressive therapy is a well known characteristic of the disease.…”

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confidence: 99%

Spontaneous Remission of Nephrotic Syndrome in Idiopathic Membranous Nephropathy

Polanco¹,

Gutiérrez²,

Covarsí

et al. 2010

Journal of the American Society of Nephrology

303

193

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Spontaneous remission is a well known characteristic of idiopathic membranous nephropathy, but contemporary studies describing predictors of remission and long-term outcomes are lacking. We conducted a retrospective, multicenter cohort study of 328 patients with nephrotic syndrome resulting from idiopathic membranous nephropathy that initially received conservative therapy. Spontaneous remission occurred in 104 (32%) patients: proteinuria progressively declined after diagnosis until remission of disease at 14.7 Ϯ 11.4 months. Although spontaneous remission was more frequent with lower levels of baseline proteinuria, it also frequently occurred in patients with massive proteinuria: 26% among those with baseline proteinuria 8 to 12 g/24 h and 22% among those with proteinuria Ͼ12 g/24 h. Baseline serum creatinine and proteinuria, treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists, and a Ͼ50% decline of proteinuria from baseline during the first year of follow-up were significant independent predictors for spontaneous remission. Only six patients (5.7%) experienced a relapse of nephrotic syndrome. The incidence of death and ESRD were significantly lower among patients with spontaneous remission. In conclusion, spontaneous remission is common among patients with nephrotic syndrome resulting from membranous nephropathy and carries a favorable long-term outcome with a low incidence of relapse. A decrease in proteinuria Ͼ50% from baseline during the first year predicts spontaneous remission.

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Efficacy and safety of 'rescue therapy' with mycophenolate mofetil in resistant primary glomerulonephritis--A multicenter study

Abstract: MMF monotherapy causes a moderate decrease in proteinuria in >50% of the patients who do not have other treatment options. The response to therapy is largely influenced by a preserved renal function and requires sustained MMF treatment.

Cited by 26 publications

References 23 publications

Mycophenolate Mofetil in High-Risk Patients with Primary Glomerulonephritis: Results of a 1-Year Prospective Study

Mycophenolate Mofetil in High-Risk Patients with Primary Glomerulonephritis: Results of a 1-Year Prospective Study

Mycophenolate mofetil in children with steroid/cyclophosphamide-resistant nephrotic syndrome

Spontaneous Remission of Nephrotic Syndrome in Idiopathic Membranous Nephropathy

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