Efficacy of mycophenolate treatment in adults with steroid-dependent/frequently relapsing idiopathic nephrotic syndrome

摘要

Background This study assessed the efficacy of therapy with mycophenolate (MF) and reduced doses of steroids in adults with steroid-dependent/frequently relapsing idiopathic nephrotic syndrome (SD/FR-INS). Methods Twenty-nine nephrotic patients (including 16 males and 13 females; mean age: 40 years, range: 18–74) were treated. Starting doses of MF were 2000?mg/day for mofetil MF (1500?mg/day in one patient) or 1440?mg/day for sodium MF. The initial prednisone (PDN) dose was 10?mg/day in 14 patients, 5?mg/day in two patients and no steroids in one patient. In the remaining 12 patients, moderate initial doses of PDN were administered (mean: 23.7?mg/day, range: 15–40), tapering to 10?mg/day after 1?month. Results Nephrotic syndrome remission was achieved in 27/29 cases (93.1%) (25 complete, 2 partial). Two patients showed resistance to the prescribed schedule. The first cycle of MF therapy was concluded in 20 patients after a mean (range) of 16.9?months (12–49). Maintenance of remission was observed in 11 of these 20 cases (55%) after a mean follow-up of 32.8?months (12–108). In nine patients with nephrotic syndrome relapse after tapering of MF (MF dependency), the same MF-PDN schedule was restarted, leading again to remission in all nine. The remaining seven MF-sensitive patients are still receiving their first therapeutic cycle. To date, the mean time under therapy in the 27 MF-sensitive patients is 38?months (4–216). Regarding complications, only minor digestive disorders and a slight decrease in blood haemoglobin levels were observed in a few patients. Conclusions MF plus reduced doses of PDN is an effective and well-tolerated therapy for adult SD/FR-INS. Though MF dependence is observed, its low toxicity could allow long periods of therapy if it is required to maintain nephrotic syndrome remission.