Treatment of Primary Systemic Vasculitis with the Inosine Monophosphate Dehydrogenase Inhibitor Mycophenolic Acid

Abstract

Despite advances in the treatment of vasculitis, modern therapies fail to induce or maintain remission in a significant proportion of patients. Mycophenolic acid is increasingly used to treat vasculitis syndromes. Here, we consider relevant pharmacokinetic and pharmacodynamic properties of mycophenolate, with emphasis on the impact of renal impairment, and we review the existing evidence for and current trials of mycophenolate in the treatment of primary systemic vasculitides.

Refractory disease in antineutrophil cytoplasmic antibodies associated vasculitis

“…Different case studies demonstrate reasonable efficacy of MMF in inducing remission in patients with AAV (reviewed in [51]). Its active metabolite mycophenolic acid suppresses guanine synthesis in lymphocytes by inhibiting inosine monophosphate dehydrogenase, and blocks DNA synthesis and proliferation after activation.…”

Lower 12-hour Trough Concentrations of Mycophenolic Acid in Patients with Active Systemic Vasculitides Taking Mycophenolate Mofetil

“…Mycophenolic acid (MPA), the active form of mycophenolate mofetil (MMF), is an immunosuppressant increasingly used for remission maintenance after induction therapy for systemic lupus erythematosus (SLE) and antineutrophil cytoplasmic antibody-associated vasculitides (AAV) 1,2 . However, no recommendations concerning optimal dose of MMF for AAV are available, and a high relapse rate might compromise its use as a first-line remission-maintenance therapy 3 .…”

Pre‐dose plasma concentration monitoring of mycophenolate mofetil in patients with autoimmune diseases

“…As maintenance therapy, the MAINTAIN study showed that MMF is as effective as azathioprine . For vasculitis, a group of disorders due to an inflammation of blood vessels, MMF has also demonstrated efficacy . MPA pharmacokinetics (PK) are complex and have been extensively studied in renal transplant recipients.…”