Mycophenolate Mofetil Monotherapy in Membranous Nephropathy: A 1-Year Randomized Controlled Trial

Background

Treatment of patients with membranous glomerulonephritis (MGN) is controversial because of the lack of clear benefit of the immunosuppressive regimens on patient or renal survival. The objective of this study is to evaluate the efficacy and safety of mycophenolate mofetil (MMF) for patients with MGN.

Study Design

1-year prospective, randomized, and controlled clinical trial.

Setting & Participants

36 patients with biopsy-proven idiopathic MGN and nephrotic syndrome.

Intervention

19 patients received MMF (2 g/d) for 12 months and 17 patients were in the control group. All patients had the same conservative treatment based on renin-angiotensin blockers, statins, low-salt and low-protein diet, and diuretics in case of edema.

Outcomes & Measurements

End points were the mean proteinuria over creatinuria ratio in mg/g throughout the study and numbers of complete and partial remissions at 1 year (month 12). Data were analyzed on an intention-to-treat analysis.

Results

Mean proteinuria over creatinuria ratio was stable in both groups throughout the study (P = 0.1). Mean proteinuria over creatinuria ratio was 4,690 ± 2,212 mg/g in the MMF group and 6,548 ± 4,601 mg/g in the control group (95% confidence interval of the difference, −619 to +4,247; P = 0.1). Remission was complete in 3 patients (1 in the MMF group, 2 in the control group; P = 0.5) and partial in 11 patients (6 in the MMF group, 5 in the control group; P = 0.9). The probability of complete or partial remission did not differ between the 2 groups after 12 months (relative risk, 0.92; 95% confidence interval, 0.48 to 1.75; P = 0.7). Kidney function was stable in the 2 groups according to estimated glomerular filtration rate and serum creatinine level.

Limitations

The small number of patients and short follow-up prevent generalizations.

Conclusions

A 12-month regimen of MMF did not decrease mean proteinuria over creatinuria ratio or increase partial and complete remissions. Serious adverse effects were observed in 4 patients (20%) receiving MMF.

Index Words: Membranous nephropathy, nephrotic syndrome, mycophenolate mofetil, randomized trial