Mycophenolate mofetil or standard therapy for membranous nephropathy and focal segmental glomerulosclerosis: a pilot study
Mycophenolate mofetil or standard therapy for membranous nephropathy and focal segmental glomerulosclerosis: a pilot study
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DOI：
10.1093/ndt/gfm538
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发表时间：
2008-06-01
影响因子：
6.1
通讯作者：
Jha, Vivekanand
中科院分区：
文献类型：
--
作者：
Nayagam, Lakshmanan Senthil;Ganguli, Anirban;Jha, Vivekanand
背景资料。目前对特发性膜性肾病(MN)和局灶节段性肾小球硬化(FSGS)所致肾病综合征患者的治疗方案是基于类固醇和/或细胞毒药物。关于霉酚酸酯(MMF)对这些疾病的影响的数据很少，而且令人困惑。在一项随机的先导研究中，我们比较了以MMF为基础的疗法和标准疗法对患有MN和FSGS的成人肾病患者诱导缓解的疗效。霉酚酸酯2g/d，疗程6个月；泼尼松龙0.5 mg/kg/d，疗程2~3个月。FSGS常规治疗方案为泼尼松龙1 mg/kg/d，疗程3~6个月；MN常规治疗方案为激素和环磷酰胺每月交替治疗6个月。主要终点是尿蛋白/肌酐比值的变化。共纳入54例患者(21例MN和33例FSGS)，28例随机接受MMF治疗(A组)，26例接受常规治疗(B组)。两组患者缓解率无差异(组和80%的MN组和70%和69%的FSGS组)。复发频率和感染发生率也是相似的。A组FSGS患者缓解较快，激素累积剂量较低。对于MN和FSGS的初次治疗，6个月的MMF治疗在短期内与常规治疗一样有效。它能更快地诱导缓解，并减少FSGS患者的类固醇暴露。需要有更多病例和更长时间随访的研究来评估其对肾功能保存的影响。
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.