Effect and Safety of Mycophenolate Mofetil in Chronic Pulmonary Sarcoidosis: A Retrospective Study

Abstract

Background: Treatment of chronic pulmonary sarcoidosis (CPS) is challenging and often requires long-term therapy with systemic corticosteroids and supplementary use of steroid-sparing agents. Objective: To examine the efficiency and safety of mycophenolate mofetil (MMF) as a steroid-sparing agent in patients with CPS. Methods: We conducted a retrospective study of patients with biopsy-proven pulmonary sarcoidosis, who were treated with MMF and systemic corticosteroids for >6 months between 2004 and 2010. Corticosteroid dose, pulmonary function parameters and radiological and clinical follow-up before and after treatment with MMF were assessed. Results: Ten patients received MMF for >6 months. MMF was introduced due to side effects (5/10 patients) and due to an inadequate response to prior therapy (5/10 patients). Median duration of treatment with MMF was 31 months (range 8-66). Therapeutic MMF plasma trough levels of 1-3 mg/l were reached with daily doses of 1,722 ± 440 mg MMF. Daily corticosteroid dose could be significantly reduced from 14.3 ± 13.3 to 6.5 ± 2.3 mg prednisolone during treatment. During follow-up, pulmonary function, symptoms and radiological signs improved in 4 patients, while 6 patients remained stable. Median change in FVC was +8.5 % (range -2 to 16). No severe adverse events that were related to combined immunosuppressive therapy occurred. Conclusion: This study indicates that the addition of MMF to corticosteroids is a viable and safe treatment option in CPS. MMF allows a significant reduction of maintenance corticosteroids to levels <10 mg/day while preserving a stable or improved clinical condition.