Efficacy And Safety Of Mycophenolate Mofetil For Patients With Idiopathic Membranous Nephropathy: A Systematic Review

Objective:Treatment of patients with idiopathic membranous glomerulonephritis (MGN) is controversial. Mycophenolate mofetil (MMF) was recently off-label used for treating idiopathic membranous nephropathy (IMN). Given its widespread use and growing concern about safety, we conducted a systematic review of mycophenolate mofetil (MMF) for the treatment of idiopathic membranous nephropathy.Methods:We searched PubMed database to perform a systematic review of relevant English-language articles until September 2009. The following terms were used: glomerulonephritis, membranous, membranous nephropathy, membranous glomerulopathy, MGN, extramembranous glomerulopathy, membranous glomerulonephropathy, idiopathic membranous glomerulonephritis, idiopathic membranous nephropathy, mycophenolate mofetil, and Cellcept. Articles assessing the efficacy and safety of MMF for treating IMN were included in this review.Results:Fifteen articles including 153 patients, composed of 3 randomized controlled trials (RCTs),1 clinical controlled trial,5 observational studies,5 case series, and 1 case report, were included in this review. Two RCTs with 22 patients showed that MMF therapy (concomitant with corticosteroids) was as effective as the comparative immunosuppressants to reduce proteinuria. However, one RCT with 19 IMN patients showed that MMF monotherapy had no benefit to proteinuria comparing with conservative treatment. Most observational studies without controls and case series/reports showed MMF was efficient in decreasing proteinuria. Adverse effects were not well described in most studies.Conclusions:MMF combined with glucocorticoid can effectively reduce proteinuria and improve (stabilize) renal function in most reported studies. However, MMF monotherapy has disappointing result. The evidence did not show that the drug is superior to conventional immunosuppressants. Double blind RCTs with larger number of patients and longer term follow-up are required to evaluate the efficacy and safety of MMF monotherapy in IMN patients.