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2015 ; 16
(9
): 772-9
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Mycophenolate mofetil plus prednisone for inducing remission of Henoch-Schönlein
purpura nephritis: a retrospective study
#MMPMID26365119
Han F
; Chen LL
; Ren PP
; Le JY
; Choong PJ
; Wang HJ
; Xu Y
; Chen JH
J Zhejiang Univ Sci B
2015[Sep]; 16
(9
): 772-9
PMID26365119
show ga
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.