Efficacy of mizoribine followed by low-dose prednisone in patients with idiopathic membranous nephropathy and nephrotic-range proteinuria.

Abstract

BACKGROUND:

Idiopathic membranous nephropathy (IMN) patients with persistent high-grade proteinuria are at the highest risk for developing end-stage renal failure. We previously reported the effects of treatment with mizoribine followed by low-dose prednisone treatment in 4 IMN patients. The purpose of the present study was to further assess the effects of this combined treatment in a larger study group.

METHOD:

Thirteen patients with IMN and nephrotic-range proteinuria received combined treatment. Mizoribine was initiated at a dose of 150 mg/day, and 2-3 months later, 20 mg/day prednisone was added to the mizoribine regimen. The dosage of prednisone and/or mizoribine was tapered according to the urinary protein-to-creatinine ratio (P/C). We evaluated patient responses for up to 12 months after the initiation of combination therapy.

RESULTS:

Before treatment, patient urinary P/C ranged from 3.7 to 15.9 g/g. Although these values did not decrease during mizoribine monotherapy, all patients showed dramatic P/C decreases over the course of combination therapy. At 3, 6, and 12 months after combination therapy, 15%, 31%, and 62% of patients attained complete remission, respectively, and all patients were in partial or complete remission 6 months after combination therapy. No notable side effects were observed.

CONCLUSION:

The addition of prednisone after mizoribine monotherapy can be beneficial for all IMN patients with nephrotic-range proteinuria syndrome. The risks associated with immunotherapy can be decreased by initially prescribing mizoribine alone, which might act as a base for establishing therapy, followed by low-dose prednisone treatment.

• Authors: Yoshihiro Matsumoto, Yasushi Shimada, Youichi Nojima, Toshiaki Moriki
• Journal: Renal failure (Ren Fail) Vol. 35 Issue 7 Pg. 936-41 (Aug 2013) ISSN: 1525-6049 [Electronic] England
• PMID: 23815417 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Glucocorticoids
• Immunosuppressive Agents
• Ribonucleosides
• mizoribine
• Creatinine
• Prednisone

Topics

• Adult
• Aged
• Creatinine (blood)
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Drug Monitoring
• Drug Therapy, Combination
• Female
• Glomerulonephritis, Membranous (blood, complications, drug therapy)
• Glucocorticoids (administration & dosage, adverse effects)
• Humans
• Immunosuppressive Agents (administration & dosage, adverse effects)
• Male
• Middle Aged
• Nephrotic Syndrome (etiology)
• Prednisone (administration & dosage, adverse effects)
• Proteinuria (etiology)
• Remission Induction
• Ribonucleosides (administration & dosage, adverse effects)
• Severity of Illness Index
• Treatment Outcome