title: Effect and safety of mycophenolate mofetil in chronic pulmonary sarcoidosis: a retrospective study.
abstract: BACKGROUND
  Treatment of chronic pulmonary sarcoidosis (CPS) is challenging and often requires long-term therapy with systemic corticosteroids and supplementary use of steroid-sparing agents.
  
  
  OBJECTIVE
  To examine the efficiency and safety of mycophenolate mofetil (MMF) as a steroid-sparing agent in patients with CPS.
  
  
  METHODS
  We conducted a retrospective study of patients with biopsy-proven pulmonary sarcoidosis, who were treated with MMF and systemic corticosteroids for >6 months between 2004 and 2010. Corticosteroid dose, pulmonary function parameters and radiological and clinical follow-up before and after treatment with MMF were assessed.
  
  
  RESULTS
  Ten patients received MMF for >6 months. MMF was introduced due to side effects (5/10 patients) and due to an inadequate response to prior therapy (5/10 patients). Median duration of treatment with MMF was 31 months (range 8-66). Therapeutic MMF plasma trough levels of 1-3 mg/l were reached with daily doses of 1,722 ± 440 mg MMF. Daily corticosteroid dose could be significantly reduced from 14.3 ± 13.3 to 6.5 ± 2.3 mg prednisolone during treatment. During follow-up, pulmonary function, symptoms and radiological signs improved in 4 patients, while 6 patients remained stable. Median change in FVC was +8.5 % (range -2 to 16). No severe adverse events that were related to combined immunosuppressive therapy occurred.
  
  
  CONCLUSIONS
  This study indicates that the addition of MMF to corticosteroids is a viable and safe treatment option in CPS. MMF allows a significant reduction of maintenance corticosteroids to levels <10 mg/day while preserving a stable or improved clinical condition.
authors.affiliation: Department of Pulmonary Medicine, University Hospital Bern (Inselspital) and University of Bern, Bern, Switzerland.
authors.forename: Anne-Kathrin
authors.initials: AK
authors.lastname: Brill
authors.forename: Sebastian R
authors.initials: SR
authors.lastname: Ott
authors.forename: Thomas
authors.initials: T
authors.lastname: Geiser
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011859:Radiography; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D017565:Sarcoidosis, Pulmonary / Q000000981:diagnostic imaging / Q000188:drug therapy*
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid