MYCOPHENOLATE MOFETIL (MMF) INDUCES REMISSION IN REFRACTORY PEDIATRIC PATIENTS WITH IBD

Abstract

127 In the last decade a variety of medications have been tested to control the symptoms in patients with moderate to severe forms of inflammatory bowel disease (IBD). Among those are 6 mercaptopurine (6 MP), cyclosporine (CyA), tacrolimus (Ts) or tumor necrosis factor α antibody (TNFαAB). Recently another drug, mycophenolate mofetil (MMF) has been tried in adults with Crohn's disease (CD) and ulcerative colitis (UC) who either didn't respond to the standard therapy or developed corticosteroids or azathioprine related complications. To the best of our knowledge this is the first case report of successful treatments of 2 pediatric patients with severe forms of CD and UC with MMF. Case #1. 17 y.o. male with history of fulminant onset of CD who developed multiple relapses after initial response to IV solumedrol and 6 MP. The combinations of prednisone with 6 MP, CyA, Ts and TNFαAB have been used without sustained clinical remission. Moreover the patient became hypotensive 36 hours after the treatment with TNFαAB. After the treatment with MMF 1 gm twice a day and low dose of prednisone 10 mg a day, the patient became asymptomatic in 2 weeks and remained in clinical remission. Case #2. 15 y.o. female with severe form of UC initially treated with IV solumedrol and 6 MP. The patient improved but developed signs of corticosteroid and 6 MP toxicity: cushinoid face, prominent striae and hepatitis. 6 MP was discontinued. Within 4-5 days after the treatment with MMF the patient became asymptomatic. The prednisone was weaned off but she remains in clinical remission. Conclusion: Our limited experience with MMF indicates it may be a promising agent in induction and maintenance of clinical remission in pediatric patients with severe forms of IBD unresponsive to the other therapeutic modalities.