Mycophenolate mofetil for ocular myasthenia

Abstract

To study the safety and tolerability of mycophenolate mofetil (MM), since this steroid-sparing immunomodulatory agent with less side effects, compared to corticosteroids, may be considered for long-term management of ocular myasthenia (OMG). Consecutive patients with OMG started on MM between December 2000 and December 2002 were followed up to December 2006. All of the 31 patients with OMG were treated with prednisone at 40-60 mg/d while MM was increased up to the target of 1.0 g/d. After symptoms completely resolved, all patients were then tapered off prednisone over a period of 4 weeks. Eighty-seven percent (27/31) of patients continued on MM during the study. Mycophenolate mofetil discontinuation occurred in 4/31 (13%) of patients within the first four months of starting the drug. Of the patients who continued on MM, 93% (25/27) remained at stage I of the disease. The 7% (2/27) of patients on MM who generalized in our study did so by 2 years and were treated with additional prednisone. MM-related adverse events included nausea in 9 of 31 patients, diarrhea in 5 of 31 patients, and vomiting in 1/31 patients. No cases of infections, cytopenias, or malignancies were observed. Eighty-seven percent of OMG patients on corticosteroids who were switched to MM remained at Stage I of the disease over a mean period of 4.2 years. MM at 1.0 g/d was safe and tolerable as a long-term immunosuppressant for OMG.