Mycophenolate mofetil in dysimmune neuropathies: a preliminary study.

Brief summary Mycophenolate mofetil (MM) is an immunosuppressant that has been used successfully for preventing the rejection of renal, heart, or liver transplants and for the therapy of immune-mediated diseases. It shows modest side effects and has a lower risk for late malignancies compared with other immunosuppressive drugs. Recently, MM has been used also for the treatment of myasthenia gravis, polymyositis, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), andmultifocal motor neuropathy (MMN). We treated four patients with possible, probable, or definite MMN and two with CIDP who were on large doses of intravenous immunoglobulins (IVIg), with the hope of reducing or with drawing IVIg while maintaining a satisfactory and stable clinical state. Four patients were also receiving other immunomodulating agents. Patients receivedoral MM in a dosage of 1 g twice daily, for an average of 9 months (range, 6–12 months). Prior to MM treatment, all patients underwent several attempts to reduce IVIg dosage, resulting in clinical worsening, even in subjects receiving other immunomodulating agents. Patients were evaluated at baseline and each month thereafter, using the Medical Research Council (MRC) sumscore and the Immune Neuropathy Course and Treatment (INCAT) arm and leg disability scores. The values of the INCAT scale at baseline ranged from 0 to 3 (mean, 1.5). Full blood count, renal and liver function, and serum amylase levels were monitored every 2 months. We found that MM, in patients with MMN and CIDP, is effective in reducing IVIg requirement and in replacing other, more toxic, drugs. Only one patient with MMN relapsed, after 4 months, perhaps because of longer duration of disease, as previously observed in another series of patients. We suggest that the association of MM with IVIg in dysimmune neuropathies, and particularly in MMN, is effective in reducing the dosage of immunoglobulins. Randomized controlled trials are warranted to further clarify the role of this immunosuppressant in the therapy of MMN and CIDP.