Abstract
Mycophenolate Mofetil M MF has been widely used in post- transplan t immunosuppression. Its ro le is emerging in GN. MMF d emonstrated p romising r esults compared with cyclosphosphamide in stage IV lupus nephritis, in a recentl y published trial. It has been found to have a wide safety profile, with m ostly gastroinetestinal side effects, which can be avoided through titration. Its action is through inhib ition of the enzyme IMDPH (ionosine monophosphate dehydrogenase), leading t o purine antagonism and i nhibition of lymphocytes. We were aiming to demonstrate the efficacy of MMF in our GN population. In this s tudy, we reviewed 17 patients who received MMF (dose - 1 gm po bid) for the past year. They were only included if it was given for the management of resistant p rimary glo merulonephritis. Co mplete remission has been defin ed as proteinuria of less than 0.5 g/da y and partial re mission as a r eduction of proteinuria <= 50% of starting MMF therapy; all 17 MMF t herapy patients uniform ly achieved good BP (< 140/80) control. MMF was used f or a minimum of 1 year and a maximum of 2 y ears. The results indicate that 7 patients (41%) had a partial remission to MMF. This group was composed of 2 m embranous GN, 2 lupus GN (stage IV and stage V) and two with FSGS (1 with single kidney not biopsied) and one with MP GN. Five of 17 (2 9%) achieved co mplete rem ission and t his gr oup co nsisted of 1 membranous GN, 2 lupus GN (type IV and membranous), one FSGS and one with MPGN. Four of 17 (23%) were non- responders to th erapy. Th is group a rticles. aspx? id= 41 to side e ffects. We conclude th at the M MF appears to be an effective alt ernate treat ment modality in resi stant membranous GN, lupus ne phritis (t ype IV and V) and possibl y MPGN, and to a lesser extent in resistant FSGS. Further prospective data may demonstrate the efficacy of MMF in GN.