Mycophenolate Mofetil Can Effectively Induce Remission in EGPA
Mycophenolate mofetil (MMF) is well-tolerated and can be used to induce remission in people with eosinophilic granulomatosis with polyangiitis (EGPA), a type of ANCA-associated vasculitis (AAV), a real-world study shows.
Two-thirds of patients with newly diagnosed or relapsing EGPA achieved remission, or had no symptoms appearing for a time, within six months of using MMF, according to the study. The findings support recommendations for the use of MMF as an induction therapy across all types of AAV.
The study, “A real-world assessment of mycophenolate mofetil for remission induction in eosinophilic granulomatosis with polyangiitis,” was published in the journal Rheumatology International by a team of researchers in the U.K.
MMF (sold as CellCept, among other names) is an immunosuppressant that lowers the body’s ability to mount an immune response. The treatment reduces interleukin-5, an immune molecule that is key for the maturation of eosinophils — the immune cells that drive EGPA.
A recent analysis of randomized controlled trials revealed that MMF may be as effective as cyclophosphamide at inducing remission in certain patients with AAV. Those trials, however, excluded patients with EGPA.
“Despite this, MMF is commonly used in these patients,” the researchers wrote.
To evaluate the effectiveness and tolerability of MMF in this specific population, the researchers examined electronic health records of 15 patients with EGPA who received MMF in combination with prednisolone (a corticosteroid) between 2009 and 2019 at two centers in Scotland.
The patients included 11 men and four women, with a median age of 57 years. Eleven patients had newly diagnosed EGPA and four patients had relapsing disease. Also, seven patients had autoantibodies against the myeloperoxidase protein, the most common in EGPA.
Disease remission — defined as a Birmingham Vasculitis Activity Score of zero, indicating no disease activity — was achieved in 67% of patients within six months after MMF initiation. This percentage was maintained at 12 months, and four patients relapsed during that period.
Of the four patients who relapsed, three had non-organ-threatening disease, which responded to an increase in the dosages of MMF and prednisolone. The other had a peripheral neuropathy, or damage to nerves outside the brain and spinal cord, which required a switch from MMF to rituximab (an antibody that works by reducing the number of immune B-cells).
Overall, MMF was found to be well-tolerated by all patients.
“Our real-world data suggest that MMF is an effective and well-tolerated agent for achieving disease remission in EGPA,” the researchers concluded, adding that randomized controlled trials are needed to confirm the findings.