Efficacy of Mycophenolate in Steroid-Dependent and Frequently Relapsing Adult Minimal Change Disease: A Retrospective Cohort Study

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2025 Feb 12

PMID 39935927

Authors

Surendra S Rathore

Kumari Nirja

Sunita Choudhary

Affiliations

Soon will be listed here.

Abstract

Background Just like in the pediatric population, minimal change disease (MCD) in adults is characterized by a high relapse rate following steroid therapy. A significant proportion of these patients become either frequent relapsers or steroid-dependent (SD). These SD or frequently relapsing (FR) adult MCD cases require additional forms of immunosuppressive therapy to avoid steroid-related adverse effects. Aim The primary objective of this study was to evaluate the efficacy of mycophenolate (MF) in maintaining complete remission in adult MCD patients with steroid dependence or frequent relapses. The secondary objective was to assess the safety and long-term outcomes of MF therapy in this patient population. Methods This retrospective cohort study included all adult biopsy-proven FR/SD MCD cases who were prescribed MF therapy during period of January 2018 till May 2024. MF drug was prescribed for 12 months duration in MF-responsive patients. After extracting baseline demographic data, these patients were retrospectively followed up to assess induction of remission and maintenance of remission after discontinuation of MF therapy. Results In the present study, 24 adult FR/SD nephrotic syndrome cases were included for analysis. MF therapy was able to maintain steroid-free remission for the whole duration of therapy (12 months) in 20 (83.3%) patients. Four patients were non-responsive to MF therapy and relapsed once steroids were withdrawn despite patients being on full dose of MF. Among 20 MF-responsive patients, there was no relapse of nephrotic syndrome in 14 (70%) patients (sustained remission) till the last follow-up, with a mean duration of 18.78±8.07 months. In six (30%) cases, there was a relapse of nephrotic syndrome after MF drug was stopped, with a mean interval of 10.16±3.65 months. Conclusions Our study concludes that MF is effective in steroid-sparing in adult FR/SD MCD patients. The MF-based therapy was able to maintain complete remission in 83.3% cases for the whole duration of therapy. Moreover, in 70% of 20 MF responsive patients, the 12 months of MF therapy achieved sustained remission till the last follow-up.

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