title: Mycophenolate mofetil substitution for cyclosporine-dependent myasthenia gravis and nephrotoxicity.
abstract: Severe autoimmune myasthenia gravis is difficult to manage and may require immunosuppression with cyclosporine. However, cyclosporine dependency is associated with the risk of nephrotoxicity. Mycophenolate mofetil is a non-nephrotoxic alternative which should be considered to rescue cyclosporine-dependent, severe myasthenia gravis sufferers with renal impairment from progression to end-stage renal failure. However, the evidence is limited and studies have not assessed the outcome of a direct substitution in these cyclosporine-dependent patients. We study three such patients who successfully converted to mycophenolate mofetil, and briefly examine the evidence behind this option. We believe that total cyclosporine withdrawal is feasible, but strongly recommend overlapping mycophenolate mofetil treatment with cyclosporine.
authors.affiliation: Department of Nephrology, Austin Health, Melbourne, Victoria, Australia.
authors.forename: A K H
authors.initials: AK
authors.lastname: Lim
authors.forename: G
authors.initials: G
authors.lastname: Donnan
authors.forename: B
authors.initials: B
authors.lastname: Chambers
authors.forename: F L
authors.initials: FL
authors.lastname: Ierino
mesh_terms: D000328:Adult; D016572:Cyclosporine / Q000009:adverse effects* / Q000627:therapeutic use; D003928:Diabetic Nephropathies / Q000139:chemically induced / Q000150:complications; D004341:Drug Evaluation; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000139:chemically induced; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced* / Q000150:complications; D007676:Kidney Failure, Chronic / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000188:drug therapy* / Q000601:surgery / Q000628:therapy; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010951:Plasma Exchange; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use; D012008:Recurrence; D013934:Thymectomy
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone; D009173:Mycophenolic Acid