Efficacy of mycophenolate mofetil in sarcoidosis

Hamzeh, Nabeel; Voelker, Allison; Forssén, Anna; Gottschall, E. Brigitte; Rose, Cecile S.; Mroz, Peggy M.; Maier, Lisa A.

doi:10.1016/j.rmed.2014.09.013

Cited by 87 publications

(45 citation statements)

References 17 publications

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“…It is associated with less nausea and pulmonary toxicity [8], but it can cause peripheral neuropathy. More recently, mycophenolate mofetil (MMF) was reported to be useful when other drugs had to be discontinued due to toxicity; however, evidence for the effectiveness of this product is rather limited [9]. It was suggested to be successful in neurosarcoidosis and cutaneous sarcoidosis [10].…”

Section: Introductionmentioning

confidence: 99%

Ranking Self-reported Gastrointestinal Side Effects of Pharmacotherapy in Sarcoidosis

Drent

Proesmans

Elfferich

et al. 2020

Lung

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Background Clinical manifestations of sarcoidosis vary widely, depending on the intensity of the inflammation and the organ systems affected. So far, no curative treatment exists; the disease can only be suppressed. All treatment options cause side effects affecting quality of life. The aim of this study was to establish and rank the prevalence of self-reported gastrointestinal side effects of drugs used in the treatment of sarcoidosis. Methods A cross-sectional web-based anonymous survey about complaints and side effects was conducted among sarcoidosis patients in the Netherlands, United Kingdom, and United States of America. Results Of the participants, 70% were being treated with one or more drugs. The most important reported side effect was weight gain, associated with increased appetite among prednisone users (as monotherapy as well as in combination with other drugs). Methotrexate (MTX) users especially experienced nausea, with monotherapy as well as combination therapy. Vomiting and weight loss were most prominent among azathioprine and mycophenolate mofetil (MMF) users, whereas diarrhoea was frequently mentioned by MMF and MTX users. The reported side effects of hydroxychloroquine were generally rather mild. Conclusion The current study ranked the gastrointestinal side effects associated with pharmacotherapy in sarcoidosis patients. Pharmacotherapy does have multiple gastrointestinal side effects. The strongest association between a reported side effect and drug use was that of weight gain associated with increased appetite among prednisone users. It would therefore be useful for future research to look further into dietary interventions to counter these side effects and reduce their burden.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Introductionmentioning

confidence: 99%

Ranking Self-reported Gastrointestinal Side Effects of Pharmacotherapy in Sarcoidosis

Drent

Proesmans

Elfferich

et al. 2020

Lung

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“…In addition, there are few reports on its use for renal sarcoidosis (68). In a retrospective study of 37 patients with pulmonary sarcoidosis, MMF did not improve pulmonary function tests but was steroid-sparing in some patients (69). Its role for pulmonary sarcoidosis is therefore not clear as of yet.…”

Section: Therapeutic Options In Refractory Sarcoidosismentioning

confidence: 99%

Refractory Pulmonary Sarcoidosis

Korsten

Strohmayer

Baughman

et al. 2016

Clinical Pulmonary Medicine

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Patients with sarcoidosis undergo spontaneous remission or may be effectively controlled with glucocorticoids alone in many cases. Progressive and refractory pulmonary sarcoidoisis constitute more than 10% of patients seen at specialized centers. Pulmonary fibrosis and associated complications, such as infections and pulmonary hypertension are leading causes of mortality. No universal definition of refractoriness exists, we therefore propose classifying patients as having refractory disease when the following criteria are fulfilled: (1) progressive disease despite at least 10 mg of prednisolone or equivalent for at least three months and need for additional disease-modifying anti-sarcoid drugs due to lack of efficacy, drug toxicity or intolerability and (2) treatment started for significant impairment of life due to progressive pulmonary symptoms. Both criteria should be fulfilled. Treatment options in addition to or instead of glucocorticoids for these patients include second- (methotrexate, azathioprine, leflunomide) and third-line agents (infliximab, adalimumab). Other immunmodulating agents can be used, but the evidence is very limited. Newer agents with anti-fibrotic properties, such as pirfenidone or nintedanib, might hold promise also for the pulmonary fibrosis seen in sarcoidosis. Treating physicians have to actively look for potentially treatable complications, such as pulmonary hypertension, cardiac disease or infections before patients should be classified as treatment-refractory. Ultimately, lung transplantation has to be considered as treatment option for patients not responding to medical therapy. In this review, we aim to propose a new definition of refractoriness, describe the associated clinical features and suggest the therapeutic approach.

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“…In patients with mild cough, inhaled corticosteroids may be beneficial, while in patients with parenchymal lung disease between 20 and 40 mg of prednisone daily is recommended for approximately 3 months before tapering to a lower dose or maintenance therapy [76]. Those patients with persistent symptoms, or progressively worsening disease may be eligible for additional immunosuppressive therapy [76], such as leflunomide [77,78], methotrexate [79] or MMF [80][81][82]. Each drug has demonstrated some effectiveness in patients with sarcoidosis; however, these treatments require further investigation in randomised, controlled studies.…”

Section: Sarcoidosismentioning

confidence: 99%

Pharmacological management of progressive-fibrosing interstitial lung diseases: a review of the current evidence

Richeldi

Varone

Bergna³

et al. 2018

Eur Respir Rev

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A proportion of patients with interstitial lung diseases (ILDs) are at risk of developing a progressive-fibrosing phenotype, which is associated with a deterioration in lung function and early mortality. In addition to idiopathic pulmonary fibrosis (IPF), fibrosing ILDs that may present a progressive phenotype include idiopathic nonspecific interstitial pneumonia, connective tissue disease-associated ILDs, hypersensitivity pneumonitis, unclassifiable idiopathic interstitial pneumonia, ILDs related to other occupational exposures and sarcoidosis. Corticosteroids and/or immunosuppressive therapies are sometimes prescribed to patients with these diseases. However, this treatment regimen may not be effective, adequate on its own or well tolerated, suggesting that there is a pressing need for efficacious and better tolerated therapies. Currently, the only approved treatments to slow disease progression in patients with IPF are nintedanib and pirfenidone. Similarities in pathobiological mechanisms leading to fibrosis between IPF and other ILDs that may present a progressive-fibrosing phenotype provide a rationale to suggest that nintedanib and pirfenidone may be therapeutic options for patients with the latter diseases.This review provides an overview of the therapeutic options currently available for patients with fibrosing ILDs, including fibrosing ILDs that may present a progressive phenotype, and explores the status of the randomised controlled trials that are underway to determine the efficacy and safety of nintedanib and pirfenidone.

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Efficacy of mycophenolate mofetil in sarcoidosis

Cited by 87 publications

References 17 publications

Ranking Self-reported Gastrointestinal Side Effects of Pharmacotherapy in Sarcoidosis

Ranking Self-reported Gastrointestinal Side Effects of Pharmacotherapy in Sarcoidosis

Refractory Pulmonary Sarcoidosis

Pharmacological management of progressive-fibrosing interstitial lung diseases: a review of the current evidence

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