Sequential Therapy with Mycophenolate Mofetil in Progressive IgA Nephropathy.

Objective: In patients with advanced progressive IgA nephropathy (IgAN), CyP therapy has been shown to arrest progression to end-stage renal disease, but some patients show further progress after CyP. Mycophenolate mofetil (MMF) is a promising drug for salvage or maintenance in sequential therapy in autoimmune diseases. In this prospective, uncontrolled trial, we evaluated the effect of MMF salvage therapy on renal function after cyclophosphamide pulse therapy (CyP) in progressive or relapsing IgAN. Methods: Thirteen patients were treated for 21 months (median, range 8 to 63 months) with MMF salvage therapy (median dose 1 g/day) who showed further increase of serum creatinine (>10%), or proteinuria >0.7 g/l after CyP induction therapy. Results: In linear regression analysis of inverse serum creatinine the median loss of renal function was 1.6 % per year after CyP, but increased again to 12.7 % per year 5 months after end of CyP. MMF significantly reduced the loss of renal function to 3.5 % per year. Overall there was a trend to a decrease in proteinuria from 1.7 to 0.9 g/l after MMF and CyP therapy. Conclusions: In conclusion, sequential therapy with MMF is effective in salvage of renal function in a subgroup of patients with further progressive or relapsing IgAN after CyP induction therapy. [ABSTRACT FROM AUTHOR]