Mycophenolate mofetil plus prednisone for inducing remission of Henoch-Schönlein purpura nephritis: a retrospective study

Abstract

Abstract:Objective: The treatment of Henoch-Schönlein purpura (HSP) with moderate proteinuria remains controversial. We retrospectively analyzed the efficacy of immune suppressants, with a particular emphasis on mycophenolate mofetil (MMF). Methods: Ninety-five HSP patients with moderate proteinuria (1.0-3.5 g/24 h) after at least three months of therapy with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) were divided into three groups: an MMF group (n=33) that received MMF 1.0-1.5 g/d combined with prednisone (0.4-0.5 mg/(kgd)), a corticosteroid (CS) group (n=31) that received full-dose prednisone (0.8-1.0 mg/(kgd)), and a control group (n=31). Patients in the MMF and CS groups continued to take ACEI or ARB at the original dose. The patients in the control group continued to take ACEI or ARB but the dose was increased by (1.73±0.58)-fold. The patients were followed up for 6-78 months (median 28 months). Results: The baseline proteinuria was higher in the MMF group ((2.1±0.9) g/24 h) than in the control group ((1.6±0.8) g/24 h) (P=0.039). The proteinuria decreased significantly in all groups during follow-up, but only in the MMF group did it decrease significantly after the first month. At the end of follow-up, the proteinuria was (0.4±0.7) g/24 h in the MMF group and (0.4±0.4) g/24 h in the CS group, significantly lower than that in the control group ((0.9±1.1) g/24 h). The remission rates in the MMF group, CS group, and control group were respectively 72.7%, 71.0%, and 48.4% at six months and 72.7%, 64.5%, and 45.2% at the end of follow-up. The overall number of reported adverse events was 17 in the MMF group, 30 in the CS group, and 6 in the control group (P<0.001). Conclusions: MMF with low-dose prednisone may be as effective as full-dose prednisone and tend to have fewer adverse events. Therefore, it is probably superior to conservative treatments of adult HSP patients with moderate proteinuria.

Rituximab therapy for IgA-vasculitis with nephritis: a case series and review of the literature

“…The data on the beneficial effects of mycophenolate mofetil are limited. Han et al [46] compared a combination of mycophenolate mofetil with low-dose prednisone versus a full-dose prednisone alone as induction therapy for IgA nephritis with heavy proteinuria (>2.0 g/24 h). After a median follow-up of 28 months in both groups, the overall remission rate was 80.8 % in the full-dose prednisone group and 77.8 % in the mycophenolate mofetil group, suggesting the two regimens to be comparative effective.…”

Off-label use of tacrolimus in children with Henoch-Schönlein purpura nephritis: a pilot study

“…For other immunosuppressive drugs, mycophenolate mofetil (MMF) showed the mean duration for return to negative proteinuria was 11±1.7 months 27. The remission rate in patients with HSPN treated with MMF and prednisone group was 72.7% at 6 months 28. In a retrospective data study of 141 children with HSPN with corticosteroid or immunosuppressive treatments (cyclophosphamide or azathioprine), 35% showed complete remission after 6 months 29.…”

Mycophenolate mofetil for the treatment of Henoch-Schönlein purpura nephritis; current knowledge and new concepts

“…Henoch-Schönlein purpura nephritis (HSPN) is the major cause of mortality and morbidity in children with HSP ( 1 ), which occurs in 30%-80% of patients during the first three weeks of the initial presentation ( 1 , 4 ).…”

“…HSPN accounts for 1.8%–3% of children with chronic kidney disease ( 5 ), and chronic renal failure might occur in 11%–38% of patients with severe manifestations and pathologic changes ( 4 ).…”

“…It has been a valuable and promising alternative agent for the treatment of complicated HSPN with steroid resistance, steroid dependence, and steroid side effects ( 2 , 5 ). Therapeutic effect of MMF associated with low dose prednisone has been as equal as full dose steroid treatment, with more than 70% remission rate ( 4 ).…”