title: Use of mycophenolate mofetil as a rescue agent in the treatment of severe generalized myasthenia gravis in three dogs.
abstract: OBJECTIVE
  To describe the use of IV and oral mycophenolate mofetil (MMF) as adjunctive therapy in 3 dogs with severe generalized myasthenia gravis.
  
  
  METHODS
  Three dogs suffering from severe generalized myasthenia gravis as confirmed by acetylcholine antibody titers were treated with MMF as part of their treatment regimens. All 3 dogs had radiographic evidence of megaesophagus and suffered from severe regurgitation. Each dog was initially treated with pyridostigmine and supportive agents. When clinical remission was not achieved, IV MMF was administered to all dogs. Signs of clinical remission were apparent within 48 hours and all dogs were later maintained on oral MMF following resolution of regurgitation.
  
  
  CONCLUSIONS
  This is the first report of the use of IV MMF as adjunctive treatment in dogs with severe generalized myasthenia gravis. Outcome was favorable in all 3 dogs and no adverse effects were noted from the MMF.
authors.affiliation: Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01356Department of Pathology, University of California, San Diego, La Jolla, CA 9037Department of Emergency and Critical Care, Angell Animal Medical Center, Boston, MA 02130.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Abelson
authors.forename: G Diane
authors.initials: GD
authors.lastname: Shelton
authors.forename: Megan F
authors.initials: MF
authors.lastname: Whelan
authors.forename: Lilian
authors.initials: L
authors.lastname: Cornejo
authors.forename: Scott
authors.initials: S
authors.lastname: Shaw
authors.forename: Therese E
authors.initials: TE
authors.lastname: O'Toole
mesh_terms: D000818:Animals; D004283:Dog Diseases / Q000188:drug therapy* / Q000473:pathology; D004285:Dogs; D004630:Emergencies / Q000662:veterinary; D005260:Female; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008297:Male; D009157:Myasthenia Gravis / Q000188:drug therapy / Q000662:veterinary*; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012720:Severity of Illness Index
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid
keywords: acetylcholine receptor antibody; immunosuppressive agents; megaesophagus; neuromuscular disease; purine analog