Impact of gastrointestinal-related side effects on mycophenolate mofetil dosing and potential therapeutic strategies
Impact of gastrointestinal-related side effects on mycophenolate mofetil dosing and potential therapeutic strategies
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DOI：
10.1111/j.1399-0012.2008.00892.x
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发表时间：
2008-11-01
影响因子：
2.1
通讯作者：
Ambuehl, Patrice M.
中科院分区：
文献类型：
--
作者：
Bunnapradist, Suphamai;Ambuehl, Patrice M.
在接受霉酚酸酯(MMF)治疗的肾移植患者中，维持适当的剂量方案已被证明可以最大化短期和长期结果。与MMF相关的胃肠道(GI)不良事件频繁发生，并导致40%-50%的MMF剂量减少或停药。在接受MMF治疗的患者出现胃肠道并发症时，一项分析报告称，停用MMF与移植物丢失风险几乎增加了三倍，而剂量减少=50%的风险增加了两倍。如果胃肠道症状改善，恢复减少前的MMF剂量，移植物丢失的增加风险可能会逆转，但持续的不耐受可能使这一点难以实现。对致病因素的调查很重要，可能会缓解症状。改用肠溶霉酚酸钠(EC-MPS)可能是一种有效的选择。两项使用患者报告的结果数据的开放标签研究表明，从MMF转换为EC-MPS后，GI相关症状负担有显著和临床相关的好处。总之，肾移植术后胃肠道并发症的监测是必不可少的，在考虑治疗方案时，保持足够的霉酚酸暴露应该是优先考虑的。
In renal transplant patients receiving mycophenolate mofetil (MMF), maintaining an adequate dosing regimen has been shown to maximize short- and long-term outcomes. Gastrointestinal (GI) adverse events associated with MMF are frequent, and lead to MMF dose reduction or withdrawal in 40-50% of cases. Among MMF-treated patients experiencing GI complications, one analysis has reported MMF discontinuation to be associated with almost a threefold increase in risk of graft loss, while a dose reduction >= 50% carried over a twofold increase in risk. If GI symptoms improve and the pre-reduction MMF dose is resumed the increased risk of graft loss may be reversed, but continuing intolerance can make this difficult to achieve. Investigation of contributing factors is important and may alleviate symptoms. Conversion to enteric-coated mycophenolate sodium (EC-MPS) may be an effective option. Two open-label studies using patient-reported outcomes data have shown a significant and clinically relevant benefit in GI-related symptom burden after conversion from MMF to EC-MPS. In conclusion, monitoring of GI complications is essential following renal transplantation, and maintaining adequate mycophenolic acid exposure should be a priority when considering treatment options.