Conversion from Mycophenolate Mofetil to Enteric-Coated Mycophenolate Sodium in Patients with Gastrointestinal Side Effects: Case Studies

Abstract

The potential benefit of the current mycophenolic acid, mycophenolate mofetil, has not yet been fully achieved in clinical transplantation because of its gastrointestinal side effects. Dose splitting, dose reduction, and drug discontinuation are strategies that are used to manage gastrointestinal symptoms. However, recently reported registry data suggest these alterations result in inadequate graft protection, leading to increased late acute rejection rates and decreased longterm graft survival. To investigate the potential use of the new enteric-coated formulation of mycophenolic acid therapy, mycophenolate sodium, and its suggested improved side effects profile. Five patients who previously had or were currently experiencing gastrointestinal side effects while taking mycophenolate mofetil were selected at random. These patients were initially switched to an equimolar dose of enteric-coated mycophenolate sodium. An increase in mycophenolate sodium doses was attempted according to symptoms. Changes in kidney function and gastrointestinal symptom scores were recorded before and after conversion. No episodes of acute rejection were observed in any patients during or after conversion. All patients experienced an overall improvement in gastrointestinal symptom scores following conversion, and an increase in mycophenolate sodium dose was achieved in 1 patient.