Can Mycophenolate Mofetil Be Successfully Tapered in Myasthenia Gravis? (P05.172)

Abstract

Objective: To determine if mycophenolate mofetil (MMF) can be tapered without worsening in patients with myasthenia gravis (MG). Background MMF is frequently used in the treatment of MG, but no studies address long term management. Design/Methods: The Duke MG Patient Database was reviewed to identify all patients who were prescribed MMF from 1999-2011. Two hundred fifty-seven patients with adequate data were identified and 147 reached Minimal Manifestation Status (MMS) or Pharmacologic Remission (PR) after starting MMF. Their records were reviewed to determine if a taper of MMF had been attempted and were analyzed for factors including initial and worst MGFA scores, duration of MG prior to starting MMF, MMF dose, and concurrent therapies. If MG symptoms recurred after the dose of MMF was tapered, the dose at which relapse occurred and the subsequent clinical course were recorded. Patients were required to be on a stable lower dose of MMF for 6 months for a taper to be deemed successful. Results: MMF taper or discontinuation was attempted in 60 of 147 patients. Forty-four attempts (73%) were successful. No significant differences were found between the taper success and failure groups, other than an increased rate of prednisone use in the relapsing group (42% vs 14%). In the sixteen patients who failed attempts at an MMF taper, most developed only ocular symptoms and 69% again achieved MMS or PR after the prior dose was restored. The mean dose at which relapse occurred was 1066 mg/day (mean starting dose 2375 mg/day). Only one patient required addition of therapy (prednisone). Conclusions: In this retrospective analysis, 73% of MG patients tolerated MMF dose reduction without worsening. Concurrent prednisone use was associated with a higher rate of taper failure. In patients who did relapse, their symptoms were minor and most improved after the prior dose was restored. Disclosure: Dr. Hobson-Webb has received personal compensation for activities with Frederick O9Connor Medical Consultants as a consultant.Dr. Hobson-Webb has received research support from Genzyme Corporation. Dr. Juel has nothing to disclose. Dr. Guptill has nothing to disclose. Dr. Massey has nothing to disclose. Dr. Sanders has received personal compensation for activities with Athena Diagnostics, Accordant Health Services, Jacobus Pharmaceuticals, CytoKinetics, Bayhill Therapeutics, and GlaxoSmithKline, Inc.