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

Abstract

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.

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

“…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.…”

The Treatment of Minimal Change Disease in Adults

“…In adults, mycophenolate mofetil has shown efficacy in case reports and small case series, 18,[60][61][62][63][64][65][66][67][68] with remission rates of 60%-80% in this limited experience.…”

Mycophenolate mofetil for primary focal segmental glomerulosclerosis: systematic review

“…After screening the remaining 37 full-text articles, 15 articles were excluded. One was excluded because 18 different intervention strategies were used and no individual data for MMF was reported, 31 eight were excluded as they did not report at least two pre-specified outcomes, [32][33][34][35][36][37][38][39] two were excluded because no primary FSGS patients were recruited, 40,41 and the remaining four excluded articles were reviews. 1,5,42,43 Finally, two ongoing studies were identified but results are not yet available.…”