Mycophenolate mofetil in combination with steroids for treatment of C3 glomerulopathy: A case series

Rupali S. Avasare, Pietro A. Canetta, Andrew S. Bomback, Maddalena Marasa, Yasar Caliskan, Yasemin Ozluk, Yifu Li, Ali G. Gharavi, Gerald B. Appel

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

Background and objectives C3 glomerulopathy is a form of complement-mediated GN. Immunosuppressive therapy may be beneficial in the treatment of C3 glomerulopathy. Mycophenolate mofetil is an attractive treatment option given its role in the treatment of other complement-mediated diseases and the results of the Spanish Group for the Study of Glomerular Diseases C3 Study. Here, we study the outcomes of patients with C3 glomerulopathy treated with steroids and mycophenolate mofetil. Design, setting, participants, & measurements We conducted a retrospective chart review of patients in the C3 glomerulopathy registry at Columbia University and identified patients treated with mycophenolate mofetil for at least 3 months and follow-up for at least 1 year. We studied clinical, histologic, and genetic data for the whole group and compared data for those who achieved complete or partial remission (responders) with those who did not achieve remission (nonresponders). We compared remission with mycophenolate mofetil with remission with other immunosuppressive regimens. Results We identified 30 patients who met inclusion criteria. Median age was 25 years old (interquartile range, 18–36), median creatinine was 1.07 mg/dl (interquartile range, 0.79–1.69), and median proteinuria was 3200 mg/g creatinine (interquartile range, 1720–6759). The median follow-up time was 32 months (interquartile range, 21–68). Twenty (67%) patients were classified as responders. There were no significant differences in baseline characteristics between responders and nonresponders, although initial proteinuria was lower (median 2468 mg/g creatinine) in responders compared with nonresponders (median 5000 mg/g creatinine) and soluble membrane attack complex levels were higher in responders compared with nonresponders. For those tapered off mycophenolate mofetil, relapse rate was 50%. Genome-wide analysis on complement genes was done, and in 12 patients, we found 18 variants predicted to be damaging. None of these variants were previously reported to be pathogenic. Mycophenolate mofetil with steroids outperformed other immunosuppressive regimens. Conclusions Among patients who tolerated mycophenolate mofetil, combination therapy with steroids induced remission in 67% of this cohort. Heavier proteinuria at the start of therapy and lower soluble membrane attack complex levels were associated with treatment resistance.

Original languageEnglish (US)
Pages (from-to)406-413
Number of pages8
JournalClinical Journal of the American Society of Nephrology
Volume13
Issue number3
DOIs
StatePublished - Mar 7 2018

Keywords

  • Complement
  • Complement Membrane Attack Complex
  • Creatinine
  • Follow-Up Studies
  • Glomerular disease
  • Glomerulonephritis
  • Humans
  • Immunosuppression
  • Immunosuppressive Agents
  • Mycophenolate mofetil
  • Mycophenolic Acid
  • Proteinuria
  • Recurrence
  • Registries
  • Retrospective Studies
  • Universities

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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