What is the role of mycophenolate mofetil (MMF) in the treatment of frequently relapsing nephrotic syndrome (FRNS)?

Updated: Mar 04, 2020
  • Author: Jerome C Lane, MD; Chief Editor: Craig B Langman, MD  more...
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Answer

Mycophenolate mofetil (MMF) has been increasingly used in FRNS and SDNS because it has fewer adverse effects than CYP, CSA, and TAC. [78] Although small studies have shown MMF to be effective in reducing the number of relapses in FRNS and SDNS, adequate randomized controlled trials still need to be performed.

One study of 33 patients, using a 6-month course of MMF with tapering-dose alternate-day steroids, achieved a 75% remission rate, which persisted in 25% of patients after discontinuation of MMF. Additionally, this study demonstrated an improvement in relapse rate from once every 2 months to once every 14.7 months. [79]  However, a multicenter, randomized, open-label study of 60 children with FRNS no difference in relapses at 2 years between MMF and CSA. [80]

MMF might be a useful steroid-sparing agent in stable patients (without excessive edema, need for hospitalization, and other serious complications) whose families wish to avoid the possible adverse effects of CYP, CSA, and TAC. However, the response to MMF varies and is less reliable than other treatments.

MMF is started at a dose of 600 mg/m2 twice daily. Complete blood cell counts should be monitored for bone marrow suppression, and liver function tests should occasionally be performed to monitor for hepatic toxicity.

MMF may be an effective and safe maintenance therapy to consider as an additive immunosuppressant after induction with rituximab in maintaining remission among children with refractory SRNS. [81]


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