Clinical experience with mycophenolate mofetil in systemic autoimmune conditions refractory to common immunosuppressive therapies

Bandelier, Cédric; Guerne, P.‐A.; Genevay, Stéphane; Finckh, Axel; Gabay, Cem

doi:10.4414/smw.2009.12441

Cited by 10 publications

(2 citation statements)

References 16 publications

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“…There are only a few reports of patients who developed MMF-related colitis (Table 1 ). A small retrospective study evaluated 11 patients with rheumatologic disease who had been treated with MMF and found that only one patient had medication-related colitis [ 7 ]. We report a case of a young female who had systemic lupus erythematosus and lupus nephritis and presented with abdominal pain and diarrhea.…”

Section: Introductionmentioning

confidence: 99%

Mycophenolate-induced colitis in a patient with lupus nephritis: a case report and review of the literature

Alakkas,

Gari,

Makhdoum

et al. 2024

J Med Case Reports

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Background Mycophenolate mofetil (MMF) is an immunosuppressive drug that is frequently prescribed to patients with rheumatological diseases. MMF’s side effects include abdominal discomfort, nausea, vomiting, and other gastro-intestinal side effects, which typically appear in the first few months of treatment. However, late-onset diarrhea does not rule out the presence of MMF-induced colitis, which can be misdiagnosed since it is linked to a broad range of histopathological characteristics, including alterations that resemble inflammatory bowel disease, graft-versus-host disease, and ischemia. The differences in treatment response may be explained by the complexity of the histopathologic characteristics. Case presentation Here we present a case of a 29-year-old Arabian female with lupus nephritis who started on MMF as induction therapy. In two months, the patient was presented to the Emergency Department with diarrhea and manifestations of severe dehydration. Infectious diseases and adverse drug events were suspected, so the patient was admitted for further workup, and MMF was stopped. The patient was diagnosed with MMF-induced colitis based on colonoscopy and histological findings. Fourteen days after stopping MMF, she was within her baseline. Conclusion The purpose of this paper is to report a case of early-onset MMF-induced colitis in a patient with lupus nephritis who had started MMF as induction therapy. A review of the available literature on this uncommon immunosuppressive effect is also presented.

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Section: Introductionmentioning

confidence: 99%

Mycophenolate-induced colitis in a patient with lupus nephritis: a case report and review of the literature

Alakkas,

Gari,

Makhdoum

et al. 2024

J Med Case Reports

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“…Within the spectrum of IIM, antisynthetase syndrome (ASS) is yet another entity in which the associated ILD is reported to respond to MMF and rituximab (21). There are also reports of successful MMF use in other rCTDs, such as IgG4-related disease (IgG4-RD) (22), relapsing polychondritis (RP) (23) and mixed connective tissue disease (MCTD) (24). It is, therefore, evident that despite its sole EMA approved indication for transplant recipients, MMF is a widely used therapy for severe and/or rare manifestations of rCTDs.…”

Section: Introductionmentioning

confidence: 99%

Off-label use of mycophenolate mofetil in the treatment of rare and complex rheumatic connective tissue diseases

Bandeira

Vieira

Guimarães

et al. 2022

Clinical and Experimental Rheumatology

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Objective. We aimed to investigate the clinical off-label use of mycophenolate mofetil (MMF), including its safety and efficacy in patients with rare and complex rheumatic connective tissue diseases (rCTDs). Methods. A survey was distributed across experts from ERN-ReCONNET reference centres to assess the experience with MMF off-label use. Patientlevel data of patients with rCTDs under treatment with MMF was also collected for analysis of safety and efficacy. Results. Twelve experts from eleven centres distributed throughout Europe (7 countries) answered the survey. The experience was concordant in that, despite its off-label use, experts reported opting frequently for this therapeutic alternative with robust confidence on its efficacy and safety. The analysis of 108 patients with rCTDs under MMF revealed a good safety profile, as well as good clinical outcomes, especially for systemic lupus erythematosus and idiopathic inflammatory myopathies. The presence of interstitial lung disease was, as expected, associated with a worse clinical outcome despite use of MMF. Conclusion. MMF is widely used in reference centres for rCTDs. Its safety profile and efficacy seem to be recognised by experts and demonstrated with patient-level analysis. While selected rCTDs will likely remain an off-label indication for MMF, robust data seem to support this therapy as an appropriate alternative for safely and effectively treating many manifestations of rCTDs.

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A real-world assessment of mycophenolate mofetil for remission induction in eosinophilic granulomatosis with polyangiitis

et al. 2021

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Eosinophilic granulomatosis with polyangiitis (EGPA) is a form of ANCA-associated vasculitis (AAV). Clinical trials demonstrating the efficacy of mycophenolate mofetil (MMF) for remission induction in AAV excluded patients with EGPA. Despite this, MMF is commonly used in these patients. The objective of this study was to evaluate, for the first time, the effectiveness and tolerance of MMF in EGPA remission induction. A retrospective, two-center, real-world study was conducted in patients with EGPA who received MMF in addition to prednisolone for newly diagnosed or relapsing disease between 2009 and 2019. Baseline, 3-, 6- and 12-month outcome data were extracted from electronic health records. The primary outcome was disease remission, defined as a Birmingham Vasculitis Activity Score of 0 at 6 months. Secondary outcomes included disease relapse, median prednisolone dose at 12 months and drug tolerance. In total, 15 patients (73% male, median age 57) with EGPA (11 newly diagnosed/4 relapsing) were identified. At 6 months, 67% had achieved disease remission. At 12 months, this was maintained (66.7%) and 4 patients had relapsed. All but one patient remained on MMF at study completion and all patients tolerated MMF. Our real-world data suggest that MMF is an effective and well-tolerated agent for achieving disease remission in EGPA. A future randomized controlled trial of MMF in this neglected orphan disease is now warranted.

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Clinical experience with mycophenolate mofetil in systemic autoimmune conditions refractory to common immunosuppressive therapies

Cited by 10 publications

References 16 publications

Mycophenolate-induced colitis in a patient with lupus nephritis: a case report and review of the literature

Mycophenolate-induced colitis in a patient with lupus nephritis: a case report and review of the literature

Off-label use of mycophenolate mofetil in the treatment of rare and complex rheumatic connective tissue diseases

A real-world assessment of mycophenolate mofetil for remission induction in eosinophilic granulomatosis with polyangiitis

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