Successful mycophenolate mofetil therapy in nine patients with idiopathic retroperitoneal fibrosis

Abstract

Objective. To assess the therapeutic benefit of mycophenolate mofetil (MMF) in retroperitoneal fibrosis (RF). Methods. MMF 2 g/day and prednisone 1 mg/kg were initiated in nine patients with radiological (9/9) and histological verification (2/9) of idiopathic RF. Out of nine patients, seven needed bilateral ureteral stenting due to extensive hydronephrosis. Results. All patients experienced regression of radiological extension. Out of seven patients, five were free of ureteral catheters after a mean of 5.6 months and two remained on stenting due to secondary stenosis. Within 6 months mean creatinine and CRP fell from 2.5 to 1.2 mg/dl and from 4.0 to 1.4 mg/dl, respectively. MMF was discontinued after a mean of 27 months. Prednisone was tapered to zero after a mean of 7 months. Side-effects were urinary tract infections in 7/9 patients and impaired glucose tolerance in 3/9. No recurrence occurred after withdrawal of glucocorticoids and MMF in 7/9 patients after a mean overall follow-up of 55 months (range 12-120). Conclusions. Treatment with MMF and glucocorticoids was successful in inducing partial or complete and lasting remission in RF. The results suggest the use of MMF as additional immunosuppressive option.

Management of idiopathic retroperitoneal fibrosis from the urologist’s perspective

“…All patients in this series had a radiological regression as well as a biological regression within 6 months of starting the treatment. CST was discontinued after a mean time of 7 months and MMF after a mean time of 27 months, with no recurrences after a mean follow-up of 55 months [Adler et al 2008]. …”

Combined Mycophenolate Mofetil and Prednisone Therapy in Tamoxifen- and Prednisone-Resistant Reidel's Thyroiditis

“…Mycophenolate mofetil, an immunomodulatory agent, has recently shown to have success in the treatment of fibrotic disorders in both case series (14)(15)(16) and in vitro models (17,18). These studies have elucidated the anti-fibrotic effects of mycophenolate mofetil in retroperitoneal fibrosis and other idiopathic fibrotic diseases.…”

Retroperitoneal fibrosis – the state-of-the-art

“…Promising results were presented by Adler et al [55]: mycophenolate mofetil (MMF) in a dosage of 2 g/day used in conjunction with prednisone was effective in inducing long-term remission with relatively few side effects.…”