Mycophenolate mofetil combined with prednisone for treatment of idiopathic membranous nephropathy with nephrotic syndrome: a 36-month prospective controlled study

Objective To explore the efficacy and safety of mycophenolate mofetil(MMF) combined with corticosteroid(prednisone) for treatment of idiopathic membranous nephropathy(IMN) for 36 months by comparing with cyclophosphamide(CTX) combined with prednisone.Methods A prospective,randomized controlled study was performed.A total of 26 patients with biopsy-proved IMN and nephritic syndrome were recruited in this study.There were 17 males and 9 females,with a median age of 43.They were evenly randomized into two groups: CTX plus prednisone(group C) and MMF plus prednisone(group M).The initial dose of prednisone was 1 mg/(kg·d) in the morning and then gradually decreased in both groups.The 24-hour urinary protein excreation,serum albumin and creatitine,estimated glomerular filtration rate(eGFR) and white cell count were examined before and 3,12,24 and 36 months after drug administration.The average median follow-up was(36.1±7.8) months.Results The proteinuria reduction and serum albumin elevation were similar in the two groups at 3,12,24 and 36 months after drug treatment,with no significant difference found at specific time points.The overall remission rates of nephrotic syndrome('complete' and 'partial') was 69.2% in group C and 77.0% in group M at 36 months after treatment,showing no significant difference between the two groups.Serum creatinine and eGFR remained stable in the two groups during follow-up.Group C had more leucopenia and abnormality of liver enzyme compared with group M.Conclusion A 36-month treatment with MMF plus prednisone is as effective as the conventional treatment with CTX plus prednisone for primary treatment of IMN with nephrotic syndrome;MMF has less adverse effects than CTX for long term treatment.It is indicated that MMF may be a reliable drug for patients with refractory IMN.