Efficacy and side effects of mycophenolate mofetil therapy in children with steroid dependent nephrotic syndrome in a tertiary paediatric nephrology centre in Sri Lanka

Abstract

Background: Mycophenolate mofetil (MMF) has been shown to be a well-tolerated drug which could maintain prolonged remission in patients with steroid dependent nephrotic syndrome (SDNS). MMF is known to have a steroid sparing effect. Objectives: To determine the effect of MMF in reducing relapses in Sri Lankan children with SDNS and to ascertain the incidence of side effects of MMF in this population. Method: Children between 1-18 years of age with SDNS who had been treated with MMF for 12 months or more at the paediatric nephrology unit, Teaching Hospital Peradeniya, were selected and reviewed retrospectively. Children who had previously received immunosuppressive therapy other than prednisolone, cyclophosphamide, cyclosporin A, tacrolimus and levamisole and those who were on MMF for indications other than idiopathic nephrotic syndrome were excluded. Children and parents were interviewed and their patient-held health records, including their 'nephrotic syndrome diary' were reviewed. Data were collected twice a week using pretested questionnaires, in the nephrotic syndrome clinic for a period of 8 weeks. Results were analysed using SPSS version 23. Results: Thirty five children who met the selection criteria were included. Of them 26 (74.3%) were male and 09 (25.7%) were female. The median age was 9.7 years. Mean number of relapses in the year before starting MMF and the year after starting MMF were 3.5 and 1.8 respectively. The reduction in the relapse rate after being on MMF was significant (p=0.009). Child's age or gender did not impact the relapse rate (p > 0.05). The most common side effect observed was cough (20%) and the least common ones were abdominal pain, dyspnoea and dizziness (3%). Conclusions: In this study MMF reduced relapse rates of children with SDNS, despite some minor side effects.