BACKGROUND: The current treatment regimes for patients with nephrotic syndrome due to idiopathic membranous nephropathy (MN) and focal segmental glomerulosclerosis (FSGS) are based on steroids and/or cytotoxic agents. Data on the effect of mycophenolate mofetil (MMF) for these conditions are scarce and confounding. METHODS: We compared the efficacy of an MMF-based therapy with standard therapies in inducing remission in adult nephrotics with MN and FSGS in a randomized pilot study. MMF was given at 2 g/day for 6 months along with prednisolone at 0.5 mg/kg/day for 2-3 months. Conventional therapy was prednisolone 1 mg/kg/day for 3-6 months for FSGS and alternating monthly cycles of steroids and cyclophosphamide for 6 months for MN. The primary end point was change in urinary protein/creatinine ratio. RESULTS: A total of 54 patients (21 MN and 33 FSGS) were recruited; 28 were randomized to receive MMF (group A) and 26 were on conventional treatment (group B). There was no difference in the proportion of patients achieving remission in two groups (64 and 80% in MN and 70 and 69% in FSGS). The frequency of relapses and incidence of infections was also similar. FSGS patients in group A achieved remission faster and received a lower cumulative steroid dose. CONCLUSIONS: A 6-month treatment with MMF is as effective as the conventional treatment for primary treatment of MN and FSGS in the short term. It induces remission faster and reduces steroid exposure in FSGS patients. Studies with more cases and longer follow-up are required to evaluate its impact on preservation of kidney function.
RCT Entities:
BACKGROUND: The current treatment regimes for patients with nephrotic syndrome due to idiopathic membranous nephropathy (MN) and focal segmental glomerulosclerosis (FSGS) are based on steroids and/or cytotoxic agents. Data on the effect of mycophenolate mofetil (MMF) for these conditions are scarce and confounding. METHODS: We compared the efficacy of an MMF-based therapy with standard therapies in inducing remission in adult nephrotics with MN and FSGS in a randomized pilot study. MMF was given at 2 g/day for 6 months along with prednisolone at 0.5 mg/kg/day for 2-3 months. Conventional therapy was prednisolone 1 mg/kg/day for 3-6 months for FSGS and alternating monthly cycles of steroids and cyclophosphamide for 6 months for MN. The primary end point was change in urinary protein/creatinine ratio. RESULTS: A total of 54 patients (21 MN and 33 FSGS) were recruited; 28 were randomized to receive MMF (group A) and 26 were on conventional treatment (group B). There was no difference in the proportion of patients achieving remission in two groups (64 and 80% in MN and 70 and 69% in FSGS). The frequency of relapses and incidence of infections was also similar. FSGS patients in group A achieved remission faster and received a lower cumulative steroid dose. CONCLUSIONS: A 6-month treatment with MMF is as effective as the conventional treatment for primary treatment of MN and FSGS in the short term. It induces remission faster and reduces steroid exposure in FSGS patients. Studies with more cases and longer follow-up are required to evaluate its impact on preservation of kidney function.
Authors: Debbie S Gipson; Howard Trachtman; Frederick J Kaskel; Tom H Greene; Milena K Radeva; Jennifer J Gassman; Marva M Moxey-Mims; Ronald J Hogg; Sandra L Watkins; Richard N Fine; Susan L Hogan; John P Middleton; V Matti Vehaskari; Patti A Flynn; Leslie M Powell; Suzanne M Vento; June L McMahan; Norman Siegel; Vivette D D'Agati; Aaron L Friedman Journal: Kidney Int Date: 2011-07-06 Impact factor: 10.612
Authors: Ronald J Hogg; Aaron Friedman; Tom Greene; Milena Radeva; Milos N Budisavljevic; Jennifer Gassman; Debbie S Gipson; J Ashley Jefferson; Eunice G John; Frederick J Kaskel; Asha Moudgil; Marva Moxey-Mims; Luis A Ortiz; Jeffrey R Schelling; William Schnaper; Tarak Srivastava; Howard Trachtman; V Matti Vehaskari; Craig Wong; Robert P Woronieki; Scott K Van Why; Anna Zolotnitskaya Journal: Clin J Am Soc Nephrol Date: 2012-11-08 Impact factor: 8.237
Authors: Debbie S Gipson; Howard Trachtman; Frederick J Kaskel; Milena K Radeva; Jennifer Gassman; Tom H Greene; Marva M Moxey-Mims; Ronald J Hogg; Sandra L Watkins; Richard N Fine; John P Middleton; V M Vehaskari; Susan L Hogan; Suzzane Vento; Patti A Flynn; Leslie M Powell; June L McMahan; Norman Siegel; Aaron L Friedman Journal: Kidney Int Date: 2010-12-22 Impact factor: 10.612