title: Can mycophenolate mofetil be tapered safely in myasthenia gravis? A retrospective, multicenter analysis.
abstract: BACKGROUND
  Mycophenolate mofetil (MMF) is frequently used to treat myasthenia gravis, but there is little information to guide clinicians on the safety of reducing the dose in well-controlled patients.
  
  
  METHODS
  This retrospective chart review at 3 institutions identified 92 patients who had undergone MMF taper after achieving either pharmacologic remission or minimal manifestations status. Statistical analysis was performed to assess differences in patient characteristics between patients who had successfully tapered MMF and those who relapsed.
  
  
  RESULTS
  Of 92 patients undergoing a taper, 30 relapsed. The relapses were mild, transient, and usually responded to increased MMF dose. MG crisis did not occur. The mean dose at time of relapse was 888 mg/day. Patients with relapses were tapered more quickly (8.4 vs. 62.4 months).
  
  
  CONCLUSIONS
  Tapering MMF appears safe after years of disease stability. Reducing the dose at a dose of only 500 mg/day every 12 months is recommended.
authors.affiliation: Department of Neurology, Duke University Medical Center, DUMC 3403, Durham, North Carolina, 27710, USA.
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Hobson-Webb
authors.affiliation: Department of Neurosciences, University of Vermont College of Medicine, Burlington, Vermont, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Hehir
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Crum
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Visser
authors.affiliation: Department of Neurology, Duke University Medical Center, DUMC 3403, Durham, North Carolina, 27710, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Sanders
authors.affiliation: Department of Neurology, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Ted M
authors.initials: TM
authors.lastname: Burns
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000175:diagnosis* / Q000188:drug therapy*; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid
keywords: monotherapy; myasthenia gravis; mycophenolate mofetil; relapse; taper