Kitiyakara C, Ophascharoensuk V, Changsirikulchai S, Ingsathit A, Tankee P, Sangpanich A, Sumethkul V
Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Clin Nephrol. 2008 Feb;69(2):90-101. doi: 10.5414/cnp69090.
Mycophenolate mofetil is an effective therapy for lupus nephritis (LN) and other glomerulonephritis (GN). However, gastrointestinal (GI) complications can limit its use. Enteric-coated mycophenolate sodium (EC-MPS) has been designed to reduce GI adverse events, but it has not been fully investigated in the treatment of GN.
Patients with LN and primary GN who had received EC-MPS were studied for effects on renal function.
30 subjects (17 LN, 13 primary GN) were studied. EC-MPS decreased proteinuria in both LN and GN. In LN, 16 patients had EC-MPS as induction therapy. Of these, 8 patients achieved complete remission (CR), 4 had partial remission (PR) and 1 improved renal function. In primary GN, CR was achieved in 4 out of 5 with minimal change disease, but only 1 did not relapse. PR was achieved in 1 of 4 patients with membranous glomerulopathy, 2 out of 2 patients with focal segmental glomerulosclerosis and 1 out of 2 patients with IgA nephropathy. Infections, anemia and alopecia were observed, but no patient had GI side effects.
EC-MPS is effective in LN, but not as effective in primary GN. The risk of GI side effects appears to be low, but other side effects can still occur.
吗替麦考酚酯是治疗狼疮性肾炎（LN）和其他肾小球肾炎（GN）的有效药物。然而，胃肠道（GI）并发症可能会限制其使用。肠溶包衣的吗替麦考酚钠（EC-MPS）旨在减少胃肠道不良事件，但在GN治疗中尚未得到充分研究。
对接受EC-MPS治疗的LN和原发性GN患者的肾功能影响进行研究。
共研究了30名受试者（17例LN，13例原发性GN）。EC-MPS可降低LN和GN患者的蛋白尿。在LN患者中，16例患者接受EC-MPS诱导治疗。其中，8例患者达到完全缓解（CR），4例部分缓解（PR），1例肾功能改善。在原发性GN患者中，5例微小病变病患者中有4例达到CR，但只有1例未复发。4例膜性肾小球病患者中有1例达到PR，2例局灶节段性肾小球硬化患者中有2例达到PR，2例IgA肾病患者中有1例达到PR。观察到有感染、贫血和脱发情况，但无患者出现胃肠道副作用。
EC-MPS对LN有效，但对原发性GN效果欠佳。胃肠道副作用风险似乎较低，但仍可能出现其他副作用。
