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Clinical Journal of the American... Sep 2007
Topics: Enzyme Inhibitors; Humans; Lupus Nephritis; Mycophenolic Acid
PubMed: 17702717
DOI: 10.2215/CJN.02740707 -
The Journal of Heart and Lung... Aug 1998Mycophenolate mofetil reduces episodes of biopsy-proven acute cellular rejection or treatment failure in the first year after kidney transplantation; however, limited... (Clinical Trial)
Clinical Trial
BACKGROUND
Mycophenolate mofetil reduces episodes of biopsy-proven acute cellular rejection or treatment failure in the first year after kidney transplantation; however, limited data exist regarding the efficacy after lung transplantation.
METHODS
In a 2-center, nonrandomized concurrent cohort study (level III evidence), we analyzed the incidence of biopsy-proven acute cellular rejection (International Society for Heart and Lung Transplantation grade > or=A2) and decrement in pulmonary function during the first 12 months after successful lung transplantation. All patients received induction immunosuppression with antithymocyte globulin (< or=5 days' duration), cyclosporine and prednisone, in addition to either mycophenolate mofetil (2.0 g/d) [n=11] or azathioprine (1 to 2 mg/kg per day) [n=11].
RESULTS
During the first 12 months after lung transplantation, the mycophenolate mofetil group experienced significantly fewer episodes of acute cellular rejection than the azathioprine group (0.26+/-0.34 vs 0.72+/-0.43 episodes/100 patient-days [mean+/-SD], p < 0.01; 95% CI for the difference=0.126 to 0.813). The change in forced expiratory volume -1 second [deltaFEV1] (liters) between the 3rd and 12th months after lung transplantation was analyzed for the two treatment groups. For this interval, deltaFEV1 for the mycophenolate mofetil group was +0.158+/-0.497 L vs -0.281+/-0.406 L for the azathioprine group (p < 0.05; 95% CI for difference=+0.0356 to 0.843). During the first year, there was 1 death in each group attributed to bronchiolitis obliterans syndrome with concurrent pneumonia. There were no differences in incidence of cytomegalovirus or bacterial infections between the treatment groups; however, a higher prevalence of aspergillus sp airway colonization in bronchoalveolar lavage fluid was observed for the mycophenolate mofetil group (p < .05). The prevalence of bronchiolitis obliterans syndrome at 12 months was 36% for the azathioprine group vs 18% for the mycophenolate mofetil group (p=NS).
CONCLUSIONS
Our preliminary experience with mycophenolate mofetil after lung transplantation suggests a decreased incidence of biopsy-proven acute cellular rejection. Furthermore, less decline in FEV1 after 12 months may suggest a reduced incidence or delayed onset for development of bronchiolitis obliterans syndrome. Prospective randomized trials with low beta error (level I evidence) should be performed to assess the efficacy of mycophenolate mofetil vis-à-vis acute allograft rejection and bronchiolitis obliterans syndrome.
Topics: Azathioprine; Cohort Studies; Double-Blind Method; Graft Rejection; Humans; Immunosuppressive Agents; Lung Transplantation; Mycophenolic Acid; Pilot Projects; Prospective Studies; Treatment Outcome
PubMed: 9730425
DOI: No ID Found -
Archives of Dermatology Jul 2009Pyoderma gangrenosum is an ulcerative condition that may be associated with inflammatory bowel disease or inflammatory arthritis. In addition to local wound care,...
BACKGROUND
Pyoderma gangrenosum is an ulcerative condition that may be associated with inflammatory bowel disease or inflammatory arthritis. In addition to local wound care, management often includes the use of systemic corticosteroids or systemically administered immunomodulatory agents.
OBSERVATIONS
We retrospectively analyzed 7 patients with pyoderma gangrenosum who were treated with mycophenolate mofetil. Patients were included if they had a diagnosis of pyoderma gangrenosum and were treated with mycophenolate mofetil for at least 2 uninterrupted months. Improvement was based on reduction in lesion size or decrease in concomitant therapy. Overall, 6 of 7 patients had some reduction in ulcer size while receiving mycophenolate mofetil therapy, and 4 of 7 completely healed. However, responsiveness was inadequate in 3 patients. Two discontinued mycophenolate mofetil for alternate therapy, and the third required the addition of dapsone and infliximab for complete healing. The only adverse event observed in our analysis attributed to mycophenolate mofetil therapy was transient anemia.
CONCLUSIONS
Mycophenolate mofetil may be beneficial as an immunomodulatory agent in selected patients with pyoderma gangrenosum. Further controlled trials are warranted to define its place among the therapeutic options for this rare disease.
Topics: Adolescent; Adult; Aged; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Mycophenolic Acid; Pyoderma Gangrenosum; Retrospective Studies; Young Adult
PubMed: 19620559
DOI: 10.1001/archdermatol.2009.57 -
American Journal of Transplantation :... Oct 2012Liver transplant recipients are at high risk of developing acute and chronic renal failure. Moreover, introduction of the model for end-stage liver disease (MELD) score... (Review)
Review
Liver transplant recipients are at high risk of developing acute and chronic renal failure. Moreover, introduction of the model for end-stage liver disease (MELD) score for primary allocation of liver grafts favors patients with pretransplant kidney dysfunction, which in turn have a higher risk of posttransplant renal failure. Calcineurin inhibitors (CNI) further increase the risk of renal failure and therefore sparing CNI with the use of mycophenolate mofetil (MMF) may improve renal function. MMF may either be used de novo in the immediate posttransplant period in combination with low-dose CNI (scenario 1) or patients that receive immunosuppression based on CNI may be converted to MMF in combination with minimization or elimination of CNI (scenario 2). Although many retrospective cohort studies and nonrandomized trials have implicated efficacy of this approach the evidence from randomized controlled studies has not been summarized. In the current review we report the results of a systematic review and meta-analysis of randomized controlled trials.
Topics: Calcineurin Inhibitors; Humans; Immunosuppressive Agents; Liver Transplantation; Mycophenolic Acid; Randomized Controlled Trials as Topic
PubMed: 22813081
DOI: 10.1111/j.1600-6143.2012.04157.x -
Revista de La Facultad de Ciencias... 2012
Review
Topics: Azathioprine; Cyclophosphamide; Humans; Immunosuppressive Agents; Lupus Nephritis; Mycophenolic Acid
PubMed: 23751789
DOI: No ID Found -
Clinical Journal of the American... Jan 2007
Review
Topics: Drug Monitoring; Graft Rejection; Humans; Immunosuppressive Agents; Mycophenolic Acid; Transplants
PubMed: 17699403
DOI: 10.2215/CJN.02860806 -
Journal of Hepatology Jul 2009
Topics: Hepatitis, Autoimmune; Humans; Immunosuppressive Agents; Mycophenolic Acid
PubMed: 19446910
DOI: 10.1016/j.jhep.2009.03.011 -
Swiss Medical Weekly Jan 2009
Topics: Autoimmune Diseases; Enzyme Inhibitors; Humans; Immunosuppressive Agents; Mycophenolic Acid
PubMed: 19169900
DOI: 10.4414/smw.2009.12612 -
Skin Therapy Letter Apr 2005Introduced in the 1970s as a treatment for psoriasis, mycophenolic acid has since been reformulated as mycophenolate mofetil (MMF). With an improved side-effect profile...
Introduced in the 1970s as a treatment for psoriasis, mycophenolic acid has since been reformulated as mycophenolate mofetil (MMF). With an improved side-effect profile and enhanced bioavailability, MMF is a promising drug for immune-mediated skin disease. Currently approved for the prevention of organ rejection, its list of "off-label" dermatologic indications continues to grow. As a noncompetitive inhibitor of inosine monophosphate dehydrogenase (IMPDH), MMF inhibits de novo purine synthesis. Its relative lack of hepatonephrotoxicity and seemingly low risk of carcinogenicity offer important therapeutic advantages. While case reports and case series dominate the dermatologic literature, preliminary results are sufficiently promising to warrant larger, randomized clinical trials with this emerging therapy.
Topics: Dermatology; Dose-Response Relationship, Drug; Enzyme Inhibitors; Humans; IMP Dehydrogenase; Immunosuppressive Agents; Mycophenolic Acid; Skin Diseases; United States
PubMed: 15986076
DOI: No ID Found -
Nephrology, Dialysis, Transplantation :... 1995
Review
Topics: Animals; Cell Division; Humans; Immunosuppressive Agents; Kidney Transplantation; Lymphocytes; Mycophenolic Acid
PubMed: 7478104
DOI: No ID Found