A six-month course of treatment with mycophenolate mofetil (MMF) is as effective as conventional therapies for treating membranous nephropathy (MN) and focal segmental glomerulosclerosis (FSGS), according to a pilot study conducted in India.
A team at the Postgraduate Institute of Medical Education and Research in Chandigarh compared MMF-based treatment with conventional regimens in inducing remission in 21 MN patients and 33 FSGS patients. The investigators, led by Vivekanand Jha, MD, randomly assigned 28 patients (11 MN and 17 FSGS) to receive MMF 2 g/day for six months along with prednisolone 1 mg/kg per day for three to six months (group A) and 26 patients (10 MN and 16 FSGS) to receive conventional treatment (group B), which was prednisolone 1 mg/kg per day for three to six months for FSGS and alternating monthly cycles of steroids and cyclophosphamide for six months for MN. Groups A and B had a mean age of 30.2 and 33.1 years, respectively. The primary end point was the change in urinary protein/creatinine ratio.
The proportion of patients achieving remission was similar in group A and group B (64% and 80% in MN patients and 70% and 69% in FSGS patients, respectively). The frequency of relapses and incidence of infections also was comparable. FSGS patients in the MMF group achieved remission faster and received a lower cumulative steroid dose.
“On the basis of this pilot study,” the authors wrote, “we can conclude that in the short term, MMF is as effective as a first-line agent as conventional forms of therapy in the management of adults with nephrotic syndrome due to FSGS and MN and is well tolerated.”