Treatment of severe IgA nephropathy: mycophenolate mofetil/prednisone compared to cyclophosphamide/prednisone

Objective: To compare the efficacy of mycophenolate mofetil (MMF)/prednisone to cyclophosphamide (CYC)/prednisone in the treatment of severe IgA nephropathy. Methods: Patients (n = 84) with severe IgA nephropathy received either MMF/prednisone (MMF group) or CYC/prednisone (CYC group). The MMF induction dose was 1.5 g/d for 6 months and the maintenance dose was 0.75 - 1.0 g/day for 12 months. The CYC induction dose was 0.8 - 1.0 g/month for 6 months and the maintenance dose was 0.8 - 1.0 g/3 months for 12 months. Laboratory tests, clinical remission rate and side effects were investigated. Results: After 18 months of treatment, the total effective rate in the MMF group was significantly higher than that of the CYC group. Patients' 24-hour urinary protein excretion in the MMF group was lower than the CYC group. Patients' plasma albumin and total protein in the MMF group was higher than the CYC group. MMF and prednisone reduced serum lipids, while in the CYC group serum lipids remained unchanged. There was also a lower incidence of adverse effects in the MMF group (4.76%) than in the CYC group (26.2%). Conclusion: Combination therapy with MMF and prednisone for severe IgA nephropathy achieved a higher remission rate compared to treatment with CYC and prednisone. This therapy also reduced the 24-hour urinary protein and serum lipids while increasing plasma albumin and improving renal function. The incidence of adverse effects was significantly lower in the MMF group compared to the CYC group.