Real-World Efficacy and Safety of Mycophenolate Mofetil in Active Moderate-to-Sight-Threatening Thyroid Eye Disease

Xian, Nicole Quah Qin; Alnahrawy, Ahmed; Akshikar, Rashmi; Lee, Vickie

doi:10.2147/opth.s305717

Cited by 18 publications

(16 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Despite these studies and according to Jiskra, the effects of biologic drugs such as MMF and cyclosporine in TED patients have not been adequately studied, and there is a controversy about their use in the treatment (17). This prospective interventional case series showed that MMF plus low-dose oral prednisolone as a new treatment regimen was significantly effective in 94.2% of patients, consistent with data previously reported on the effect of MMF on moderate to severe GO (16,(18)(19)(20)(21). Similar to the results of teprotumumab (novel insulin-like growth factor I receptor antibody) in active TED (22,23), as expected, MMF plus low-dose oral prednisolone showed the greatest effectiveness on CAS, proptosis and diplopia, and this factor significantly decreased during the study, and this decrease occurred earlier in CAS than proptosis and diplopia, suggesting that; MMF like teprotumumab was more efficient than corticosteroids in controlling local inflammation.…”

Section: Discussionsupporting

confidence: 84%

“…The MMF dosage that was initially used in combination with low-dose prednisolone, according to the study design, was based on a previous work in autoimmunity (24)(25)(26). A previous study showed that even low doses of MMF (1,000 mg/d) were effective in suppressing orbital inflammation (16)(17)(18)(19)(20)(21). However, in our study, to better respond to MMF, we added the lowest dose of corticosteroids (oral prednisolone, 5 mg/d) to the treatment regimen.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Mycophenolate Mofetil (CellCept®) in Combination With Low Dose Prednisolone in Moderate to Severe Graves' Orbitopathy

et al. 2022

View full text Add to dashboard Cite

Although corticosteroids are currently the first-choice drug for thyroid eye disease (TED), in 20–30% of cases, patients show poor or non-existent responses, and when the drug is withdrawn, 10–20% of patients relapse. Thus, in this study, we aimed to investigate the efficacy of the combined use of mycophenolate mofetil (CellCept®) and low dose oral prednisolone in patients with moderate to severe Graves' orbitopathy (GO). For the first time, we investigated the relationship between TED-related parameters and proptosis reduction. In a prospective, non-randomized, interventional case series, 242 patients with moderate-to-severe GO were, assigned to receive oral prednisolone (5 mg/ d) and mycophenolate mofetil (CellCept®) (one 500 mg tablet twice per day according to the therapeutic response). The patients were monitored regularly during the 3rd, 6th, 12th, and 18th month of treatment. The main outcome measures were the clinical activity score (CAS), intraocular pressure (IOP), diplopia, proptosis and visual acuity. We also assessed the relationship between the main outcomes with proptosis changes and time to improvement (months). Adverse effects were recorded during each visit. The clinical response rate increased from 67.7% on the third month to 89.2% on the sixth month, and 94.2% on the 12th month. This therapeutic response continued until the 18th month of follow-up. The CAS responses [disease inactivation (CAS <3)] improved during our study: 70.6% on the third month, 90.0% on the sixth month, and 92.5% at 12th month. These conditions continued until the 18th month of follow-up. Proptosis improvement was 52% on the third month, 71% on the sixth month, 83% on the 12th month, and 87.1% on the 18th month. Changes in IOP and visual acuity were not significant (P = 0.568 and 0.668, respectively). The patient showed significant improvement in the Gorman score. A Shorter duration of treatment was seen in patients with earlier onset of intervention, younger age, and lack of all extraocular muscle (EOM) enlargement on computed tomography (CT) scan (p < 0.05). In addition, a better response (more reduction) in proptosis was related to: younger age at disease, earlier treatment intervention (less interval from the time the diagnosis of moderate-to-severe GO was made until medication initiation), shorter treatment time (less time to improvement), less IOP, lack of EOM enlargement on CT scan, and lack of diplopia (P < 0.05). Adverse events occurred in six patients. Findings show that mycophenolate mofetil (CellCept®) plus low-dose prednisolone can be introduced as a new optimal dosing regimen in GO due to its better effect on chronic complications such as proptosis and diplopia.

show abstract

Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Mycophenolate Mofetil (CellCept®) in Combination With Low Dose Prednisolone in Moderate to Severe Graves' Orbitopathy

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Riedl et al analyzed the AEs of moderate-dose MMF in GO patients, and the results showed that MMF was well tolerated [ 31 ]. Currently, MMF is mostly used to treat patients with active moderate-to-severe GO who are resistant to GC, and some studies indicate that MMF is safe and effective as a second-line immunosuppressant [ 32 , 33 ]. The 2021 EUGOGO recommended intravenous MP in combination with MMF as a first-line treatment, taking all factors into account.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of mycophenolate mofetil in the treatment of moderate to severe Graves’ orbitopathy: a meta-analysis

Feng

Zhang

et al. 2022

Bioengineered

View full text Add to dashboard Cite

The role of mycophenolate mofetil (MMF) in the treatment of Graves’ orbitopathy (GO) has attracted much attention. This study is to evaluate the benefit and safety of MMF in moderate-to-severe GO. A meta-analysis of clinical control trials comparing MMF (with or without glucocorticoid (GC)) for the treatment of GO with GC was conducted. We searched the databases, including PubMed, EMBASE, the Cochrane Library, Web of Science, Wanfang, and China National Knowledge Infrastructure (CNKI), for articles published up to 15 June 2022. The primary outcome is referred to the improvement in overall response, and secondary outcomes included the change in clinical activity score (CAS) and adverse events (AEs). Of the 289 articles initially searched, 6 studies were finally eligible for inclusion. The results showed that MMF (with or without GC) was superior to GC in the treatment of GO (OR 3.34, 95% CI 2.17–5.14; p < 0.00001). Subgroup analyses also showed that MMF monotherapy was more effective than GC (OR 4.46, 95% CI 2.52–7.87; p < 0.00001). Compared to methylprednisolone (MP) monotherapy, a combination of MP and MMF was more effective. CAS decreased even more significantly (WMD 0.29, 95% CI 0.10–0.48; p = 0.002) and fewer AEs occurred (OR 0.2, 95% CI 0.06–0.72; p = 0.01) in patients receiving MMF. The pooled data suggested that MMF treatment in GO might be promising. Compared with GC therapy, MMF is safer and more effective. However, more large-sample and high-quality studies targeting MMF use in GO patients and long-term surveillance of prognosis are urgently needed.

show abstract

“…2020; Quah Qin Xian et al. 2021). Rituximab is a monoclonal antibody directed against CD20, which has been used successfully to treat active, moderate‐to‐severe GO since 2006 (Salvi et al.…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of different treatment modalities for active, moderate‐to‐severe Graves' orbitopathy: a systematic review and network meta‐analysis

Yang

Song

et al. 2021

Acta Ophthalmologica

View full text Add to dashboard Cite

To compare the effects of different treatment modalities on active, moderate-tosevere Graves' orbitopathy (GO). We searched PubMed and Embase for randomized controlled trials published up to 30 Nov 2020, of different modalities for the treatment of active, moderate-to-severe GO. We performed Bayesian network meta-analyses. This study is registered with PROSPERO (CRD42020166287). Fifteen RCTs were identified. Network meta-analysis showed that in comparison with placebo, teprotumumab, mycophenolate plus intravenous glucocorticoids (IVGCs), mycophenolate, rituximab, azathioprine, IVGCs, orbital radiotherapy, oral glucocorticoids (OGCs) were effective treatments (ordered from most effective to least effective). Teprotumumab was more efficacious in reducing proptosis than IVGCs. No significant difference in changes in diplopia grade was recorded between teprotumumab, rituximab, orbital radiotherapy and IVGCs. Low (4.5-5 g), middle (6 g) and high (7-8 g) cumulative doses of IVGCs were shown to be more effective than OGC in improving the overall response rate, but the very low-group (<3 g) seemed to have a lower risk of adverse events. We found that teprotumumab offered the highest level of efficacy in terms of the overall response rate and was more efficacious in reducing proptosis than IVGCs. With regard to different dosages of IVGCs, the cumulative dose of 4.5-5 g of IVGCs seems to be the most appropriate schedule in terms of efficacy and safety outcomes. Due to the limited number of patients treated with teprotumumab and the lack of comparison with other effective therapeutics, teprotumumab might not become the standard firstline therapy for active, moderate-to-severe GO.

show abstract

Real-World Efficacy and Safety of Mycophenolate Mofetil in Active Moderate-to-Sight-Threatening Thyroid Eye Disease

Cited by 18 publications

References 22 publications

Mycophenolate Mofetil (CellCept®) in Combination With Low Dose Prednisolone in Moderate to Severe Graves' Orbitopathy

Mycophenolate Mofetil (CellCept®) in Combination With Low Dose Prednisolone in Moderate to Severe Graves' Orbitopathy

Efficacy and safety of mycophenolate mofetil in the treatment of moderate to severe Graves’ orbitopathy: a meta-analysis

Comparative effectiveness of different treatment modalities for active, moderate‐to‐severe Graves' orbitopathy: a systematic review and network meta‐analysis

Contact Info

Product

Resources

About