Mycophenolate mofetil-based treatment for oral mucosal disease in a UK oral medicine department

Abstract

Introduction Mycophenolate mofetil (MMF) is often used in oral medicine. Reasons include its efficacy in treating inflammatory diseases, its steroid sparing property and its favourable side effects profile. There is, however, limited scientific evidence to justify its use in oral medicine. The aim of this study was to review the indications and prescribing practice relating to MMF in a tertiary oral medicine centre, and to document its tolerability and efficacy. Methods A retrospective record review was undertaken of patients prescribed MMF between January 2019 and January 2022 at Bristol Dental Hospital. Patients were identified from a local database set up to highlight and monitor departmental immunosuppressant medication usage. Medical records were assessed using a standardised data collection proforma. Results Twenty-five patients (20 female, 5 male; median age 64 years) were included in the study. The conditions for which MMF was prescribed comprised oral lichen planus (48%), mucous membrane pemphigoid (36%), pemphigus vulgaris (12%) and recurrent aphthous stomatitis (4%). Typically, MMF was prescribed at 500 mg twice daily. The median duration of treatment was 28 months. Side effects were documented in 52% of patients. In all cases, MMF was commenced owing to inadequate response to previous treatments. Over half (56%) of the patients discontinued systemic prednisolone while using MMF. Overall, 80% achieved complete clinical improvement. Conclusions MMF is effective and well tolerated in oral medicine patients. Its use is comparable with that documented in the dermatology literature.