Mycophenolate Mofetil Monotherapy in Membranous Nephropathy: A 1-Year Randomized Controlled Trial

Dussol, B.; Morange, Sophie; Burtey, Stéphane; Indreies, Monica; Cassuto, Élisabeth; Mourad, Georges; Villar, Emmanuel; Pouteil‐Noble, Claire; Karaaslan, Hüseyin; Sichez, Hélène; Lasseur, Catherine; Delmas, Y; Nogier, Marie-Béatrice; Fathallah, Mohamed; Loundou, Anderson; Mayor, Valérie; Berland, Yvon

doi:10.1053/j.ajkd.2008.04.013

Cited by 96 publications

(66 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, most patients cannot afford targeted therapeutic agents because of their high cost. [15][16][17][18] Although the efficacy of LEF for the treatment of refractory NS has only rarely been reported, the present survey showed LEF to be a suitable immunomodulatory medicine that has been safely and effectively used in the therapy of rheumatoid arthritis in psoriatic arthritis, ankylosing spondylitis, secondary Sj€ ogren's syndrome polyoma BK virus nephropathy, and systemic lupus erythematosus (SLE). [19][20][21][22]23 LEF is also as a rescue treatment in ganciclovir-resistant infection in kidney transplant recipients, 24,25 and it is effective in the treatment of adult Henoch-Sch€ onlein nephritis with nephrotic protein-urea.…”

Section: Discussionmentioning

confidence: 77%

Efficacy of leflunomide combined with prednisone in the treatment of refractory nephrotic syndrome

Liu

Chen

et al. 2016

Renal Failure

View full text Add to dashboard Cite

Objective: To assess the safety and clinical efficacy of leflunomide (LEF) and prednisone on refractory nephrotic syndrome (RNS). Methods: A total of 52 patients with RNS were treated for 24 weeks between 2010 and 2014 in our hospital. In the treated group, 26 patients were treated with LEF and prednisone, and, in the control group, 26 patients were treated with cyclophosphamide (CTX) and prednisone. During the treatment, 24 h urinary protein excretion and the serum levels of albumin and cholesterol, and kidney function were assayed before and after the therapy. Adverse reactions during treatment were recorded. Results: In the LEF group, the medication was markedly effective in eight cases and effective in nine cases; the total efficacy rate was 65.30%. In the CTX group, the treatment was markedly effective in six cases and effective in nine cases; the total efficacy rate was 57%. There were no significant differences between the results of the total efficacy rate (p > .05). The 24 h urinary protein excretion and serum cholesterol levels in both groups decreased after therapy and the serum levels of albumin in both groups increased after therapy. There were significant differences between the results for the 24 h urinary protein excretion, serum levels of albumin and cholesterol in the two groups (p < .05). The treatments were well tolerated in both groups. Conclusion: LEF combined with prednisone has a certain efficacy on the RNS and displays few adverse reactions. A large-sample, randomized double-blind controlled study and long-term follow-up are needed to verify the efficacy of LEF combined with prednisone. ARTICLE HISTORY

show abstract

Section: Discussionmentioning

confidence: 77%

Efficacy of leflunomide combined with prednisone in the treatment of refractory nephrotic syndrome

Liu

Chen

et al. 2016

Renal Failure

View full text Add to dashboard Cite

show abstract

“…Negative results have been reported by a French trial (38), in which 36 patients were randomized to receive MMF as monotherapy (2 g/d for 12 months) or symptomatic therapy. No difference in remission was seen between the two groups.…”

Section: What Treatment Regimens Are Effective and Safe For Patients mentioning

confidence: 97%

Glomerular Diseases

Ponticelli

Glassock

2014

Clinical Journal of the American Society of Nephrology

173

128

View full text Add to dashboard Cite

SummaryMembranous nephropathy (MN) is an autoimmune disease usually associated with a nephrotic syndrome and it may progress to ESRD in the long term. Its etiology is often unknown (idiopathic MN), whereas other cases have a recognizable etiology (secondary MN). In idiopathic MN, the glomerular lesions are mainly caused by autoantibodies against a podocyte membrane protein, the M-type of phospholipase A2 receptor 1. The natural course of idiopathic MN is quite varied with spontaneous complete or partial remissions a relatively common occurrence. Patients with asymptomatic non-nephrotic proteinuria seldom progress and need only conservative management. Those with persistent full-blown nephrotic syndrome and those with declining renal function are candidates for specific treatment with any of several regimens. Cyclical therapy with alternating monthly intravenous and oral glucocorticoids combined with a cytotoxic agent can induce remission and preserve renal function in the long term. Cyclosporine or tacrolimus can induce remission, but relapses are frequent after the drug withdrawal. Mycophenolate mofetil monotherapy seems to be ineffective, but may be beneficial when administered together with steroids. The experience with adrenocorticotropic hormone, natural or synthetic, is limited to a few studies with short-term follow-up, but high rates of remission can be seen after prolonged treatment. A high rate of remission and good tolerance have also been reported with rituximab. Patients with moderate renal insufficiency may also benefit from treatment, but at a price of frequent and serious side effects. With these limitations in mind, idiopathic MN may be considered a treatable disease in many patients.

show abstract

“…Etiological treatments include immunosuppressive therapies such as glucocorticoids, cyclophosphamide, MMF, cyclosporin A, FK506, and azathioprine. Currently, the consistent view towards the treatment of IMN is that hormone therapy alone has a non-significant effect on IMN (Cattran et al, 1989;Beck et al, 2013), and many scholars advocate the combined use of immunosuppressant therapy (Ponticelli et al, 1998;Goumenos et al, 2006;Jha et al, 2007;Ponticelli, 2007;Dussol et al, 2008;Quaglia and Stratta, 2009;Kalliakmani et al, 2010;Polanco et al, 2010;Cattran et al, 2011;Howman et al, 2013). It is suggested that high-risk patients with deteriorated renal function should be given an active combination therapy of glucocorticoids and immunosuppressant, whereas in low-risk IMN patients, the adverse effects of glucocorticoid and immunosuppressant therapy should be avoided where possible (Quaglia and Stratta, 2009).…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological analysis of idiopathic membranous nephropathy in young adults

Y¹,

Wang²,

Li³

et al. 2015

Genet. Mol. Res.

View full text Add to dashboard Cite

ABSTRACT. The aim of this study was to understand the clinicopathological features and prognosis of idiopathic membranous nephropathy (IMN) in youth. A retrospective analysis of the clinicopathological features and prognoses of pathologically confirmed IMN in 21 patients aged 15-30 years was performed. IMN was mainly characterized as nephrotic syndrome (NS), with stage I as the main pathological stage, and associated with hyperplasia of the glomerular mesangial cells and ground substance. High-intensity immunofluorescence also showed multi-site deposition of a variety of immune complexes, and electron microscopy showed multi-site deposition of electron-condensing substances. In the present study, 4 patients received non-specific treatment. Among 17 NS patients, 12 patients exhibited a preference for glucocorticoid therapy, and of these patients, 7 were sensitive to therapy and 5 were resistant. In the 12 patients who received hormone treatment combined with immunosuppressants (including 5 patients who were treated with the combination from the initial start, 5 patients who were steroid resistant, and 2 patients who were sensitive to the initial hormone treatment but who later showed relapse), complete remission was achieved in 6 patients, partial remission was achieved in 2, the treatment was Y. Wang et al. 4542©FUNPEC-RP www.funpecrp.com.br Genetics and Molecular Research 14 (2): 4541-4548 (2015) ineffective in 2, and 2 patients were lost to follow-up. In conclusion, the clinical manifestation of IMN in youth in this study was mainly NS. In most patients, the initial hormone treatment was effective, and in some patients, the combination of hormone and immunosuppressant treatment was effective. As the sample size in this study was small, further clinical validation is still required to determine the efficacy of the treatment.

show abstract

Mycophenolate Mofetil Monotherapy in Membranous Nephropathy: A 1-Year Randomized Controlled Trial

Cited by 96 publications

References 27 publications

Efficacy of leflunomide combined with prednisone in the treatment of refractory nephrotic syndrome

Efficacy of leflunomide combined with prednisone in the treatment of refractory nephrotic syndrome

Glomerular Diseases

Clinicopathological analysis of idiopathic membranous nephropathy in young adults

Contact Info

Product

Resources

About