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Mycophenolate mofetil plus prednisone for inducing remission of Henoch-Schönlein purpura nephritis: a retrospective
Fei Han1, Liang-liang Chen1, Ping-ping Ren1
1Kidney Disease Center, the First Affiliated Hospital, School of Medicine, Zhejiang University / Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province / the Third Grade Laboratory under the National State, Administration of Traditional Chinese Medicine, Hangzhou 310003, China.
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.
Insights
Mycophenolate mofetil (MMF) combined with low-dose prednisone offers effective treatment for Henoch-Schönlein purpura (HSP) with moderate proteinuria. This combination therapy shows comparable efficacy to full-dose corticosteroids but with a better safety profile.
Area of Science:
- Nephrology
- Immunology
- Pediatrics
Background:
- Henoch-Schönlein purpura (HSP) is a common vasculitis, particularly in children, characterized by purpura, arthritis, abdominal pain, and glomerulonephritis.
- Moderate proteinuria in HSP patients often necessitates immunosuppressive therapy, but optimal treatment strategies remain debated.
- Angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) are frequently used as initial therapy for proteinuria in HSP.
Purpose of the Study:
- To evaluate the efficacy and safety of mycophenolate mofetil (MMF) in combination with low-dose prednisone for treating adult patients with Henoch-Schönlein purpura (HSP) and moderate proteinuria.
- To compare the outcomes of MMF-based therapy with standard corticosteroid treatment and conservative management involving ACEI/ARB therapy.
Main Methods:
- A retrospective analysis of 95 adult HSP patients with moderate proteinuria (1.0-3.5 g/24 h) receiving ACEI or ARB therapy.
- Patients were divided into three groups: MMF (MMF + low-dose prednisone), corticosteroid (CS) (full-dose prednisone), and control (increased ACEI/ARB dose).
- Follow-up duration ranged from 6 to 78 months (median 28 months), assessing proteinuria levels, remission rates, and adverse events.
Main Results:
- The MMF group showed a significant decrease in proteinuria within the first month, with final proteinuria levels comparable to the CS group but significantly lower than the control group.
- Remission rates at six months and end-of-follow-up were higher in both MMF and CS groups (around 72.7% and 71.0% respectively) compared to the control group (48.4%).
- The MMF group reported fewer adverse events (17) compared to the CS group (30), while the control group had the fewest (6).
Conclusions:
- Mycophenolate mofetil (MMF) combined with low-dose prednisone is an effective treatment for adult HSP patients with moderate proteinuria, achieving similar efficacy to full-dose corticosteroids.
- This MMF-based regimen is associated with a lower incidence of adverse events compared to high-dose corticosteroid therapy.
- MMF with low-dose prednisone appears to be a superior therapeutic option compared to conservative management with escalated ACEI/ARB doses for moderate proteinuric HSP.
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