Objectives To determine whether Mycophenolate mofetil (MMF) is an effective steroid sparing agent in a single centre cohort of severe asthma patients.
Background MMF is a powerful inhibitor of purine and pyrimidine synthesis via the de novo pathway, upon which lymphocyte production is dependent. It is currently licensed for use in transplant rejection prophylaxis. Other immunosuppressant therapies have been used off licence in difficult-to-treat asthma patients under specialist supervision in an effort to reduce corticosteroid use. MMF is currently a third line immunosuppressant after methotrexate and azathioprine at the North West Lung Centre.
Methods A retrospective data analysis was performed including all patients under specialist asthma care at UHSM that were previously or currently treated with MMF. Annualised average daily steroid dose was calculated from the available data in patient case notes. This was calculated for 12 months prior to commencing any immunosuppressant therapy and during MMF treatment. Exacerbation and hospital admission rates were also recorded.
Results A total of 34 patients were identified as being on MMF for severe asthma for at least 8 weeks. 11 did not tolerate MMF or had no response and subsequently stopped. The primary analysis was carried out on 23 patients and a secondary post hoc analysis was performed on all patients who had been on treatment for a minimumof 6 months at the time of the study (N=12). The average yearly steroid sparing impact of MMF was 5.9 mg per day, (p < 0.005). 74% had an overall reduction and 35% achieved a reduction of 10 mg or more. This value was lower in those who had been on treatment for >6 months (Δ 3.9 p = 0.20). There was no statistically significant reduction in admission or exacerbation rates.
Conclusion MMF has shown a small steroid sparing effect in this retrospective analysis, although the effect appeared less positive in the sub-group of those analysed after being on treatment for at least 6 months further analysis of the potential benefits of MMF in this patient population is required.
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