NDT Advance Access originally published online on February 20, 2007
Nephrology Dialysis Transplantation 2007 22(5):1351-1360; doi:10.1093/ndt/gfl805
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Efficacy and safety of ‘rescue therapy’ with mycophenolate mofetil in resistant primary glomerulonephritis—A multicenter study*
1Servicio de Nefrología Hospital Vall d'Hebron, Barcelona, 2Servicio de Nefrología, Hospital Arnau de Vilanova, Lérida, 3Servicio de Nefrología Hospital de Cruces, Bilbao, 4Servicio de Nefrología, Hospital Clíinico de Valencia, Valencia, 5Servicio de Nefrología, Hospital 12 de Octubre, Madrid, Spain, 6Servicio de Nefrología Gregorio Marañón, Madrid, 7Servicio de Nefrología Hospital Luis Alcanyis, Alicante, 8Servicio de Nefrología, Hospital Son Dureta, Palma de Mallorca and 9Servicio de Bioquímica, Hospital Vall d'Hebron, Barcelona, Spain
Correspondence and offprint requests to: Dr Alfons Segarra, Servicio de Nefrología, Anexo planta 7a, Hospital Valle Hebrón, Paseo Valle Hebrón 119-129, Barcelona 08035, Spain. Email: alsegarr{at}vhebron.net
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Abstract |
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Background. Studies of mycophenolate mofetil (MMF) in primary glomerulonephritis have varied in their inclusion criteria, regimen and follow-up compromising assessments of efficacy and optimal dose.
Method. This multicentre study analysed the safety and efficacy of MMF monotherapy in a large cohort with primary glomerulonephritis that was resistant to other conventional therapies. A total of 98 patients with biopsy-proven primary glomerulonephritis resistant to other drugs received MMF monotherapy for 1 year. Primary outcome measures were urinary protein excretion and the number of patients with complete or partial remission of proteinuria. Secondary analyses were time to remission and changes in the slope of creatinine clearance.
Results. Fifty-four percent of the patients achieved either complete or partial remission of proteinuria with no significant differences between glomerulonephritis types. Median (range) dose of MMF was 2 g/day (1.5–2 g/day) Mean (SD) treatment time to remission was 141.5 (±61.1) days with no significant differences between glomerulonephritis types. Serum albumin increased (P < 0.01), whereas proteinuria (P < 0.01) serum LDL-cholesterol (P < 0.01) and mean blood pressure (P < 0.05) decreased post-treatment. No significant changes were observed in glomerular filtration rate (GFR), serum creatinine or slopes of GFR. The reduction of urinary protein excretion was significantly higher in patients with basal nephrotic proteinuria and preserved renal function; it did not arise from an increased dose of angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists, since, among responders, mean blood pressure significantly decreased and the number of anti-hypertensive drugs could be reduced.
Conclusions. 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.
Keywords: mycophenolate mofetil; primary glomerulonephritis; resistant glomerulonephritis
* This work was presented as a poster at the XLIII ERA Congress in Glasgow, July 2006
Received for publication: 18. 9.06
Accepted in revised form: 11.12.06
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  A. Kazory, L. C. Racusen, A. R. Berliner, L. F. Gimenez, and B. G. Jaar Mycophenolate mofetil as a possible therapeutic option for idiopathic membranoproliferative glomerulonephritis NDT Plus, August 21, 2008; (2008) sfn102v1. [Full Text] [PDF]
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