Abstract
Mycophenolate mofetil (MMF) has recently been reported as a useful alternative immunosuppressive drug in autoimmune diseases including in Takayasu arteritis (TA). The aim of this study was to verify the efficacy and tolerability of MMF administration in controlling TA disease activity and allowing glucocorticosteroid reduction. Ten consecutive active TA patients followed at the Vasculitis Clinic were enrolled from January 2003 to 2006 and received oral MMF (2 g/day) for an average of 23.3 months. Disease activity assessed using the National Institutes of Health criteria, clinical features, and inflammatory laboratory findings were evaluated. Five patients had received at least one immunosuppressive drug before administration of MMF (four methotrexate, two azathioprine, and one chlorambucil) but had not achieved clinical and laboratory remission. The other five patients received MMF as their first immunosuppressive drug because of an important disease flare during steroid dose reduction. Clinical activity disappeared in all patients with MMF therapy, except in one patient who abandoned the study because of an important headache, attributed to the drug. Moreover, the MMF therapy allowed significant tapering of the prednisone dose in the rest of the nine patients (24.5 ± 17.1 vs 5.8 ± 7.8 mg/day; p = 0.0019). Reinforcing this finding, a significant reduction in inflammatory laboratory parameters, erythrocyte sedimentation rate (24.7 ± 15.5 vs 12.8 ± 10.8 mm/h; p = 0.036) and C-reactive protein (24.0 ± 14.9 vs 11.2 ± 10.7 mg/l; p = 0.0167), was observed. In summary, MMF therapy reduced clinical and laboratory parameters of TA disease activity, suggesting that this drug is a promising immunosuppressive drug, particularly in refractory cases and as a steroid-sparing agent.
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Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, Hoffman GS (1994) Takayasu arteritis. Ann Intern Med 120:919–929
Hoffman GS, Ahmed AE (1998) Surrogate markers of disease activity in patients with Takayasu’s arteritis. A preliminary report from The International Network for the Study of the Systemic Vasculitides (INSSYS). Int J Cardiol 66:S191–S194
Daina E, Schieppati A, Remuzzi G (1999) Mycophenolate mofetil for the treatment of Takayasu arteritis: report of three cases. Ann Intern Med 130:422–426
Hoffman GS, Merkel PA, Brasington RD, Lenschow DJ, Liang P (2004) Anti-tumor necrosis factor therapy in patients with difficult to treat Takayasu arteritis. Arthritis Rheum 50:2296–2304
Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM, Fauci AS, Leavitt RY, Lie JT, Lightfoot RW Jr et al (1990) The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 33:1129–1334
Hata A, Noda M, Moriwaki R, Numano F (1996) Angiographic findings of Takayasu arteritis: new classification. Int J Cardiol 54:S155–S163
Park MC, Lee SW, Park YB, Chung NS, Lee SK (2005) Clinical characteristics and outcomes of Takayasu’s arteritis: analysis of 108 patients using standardized criteria for diagnosis, activity assessment, and angiographic classification. Scand J Rheumatol 34:284–292
Park MC, Lee WS, Park YB, Lee SK (2006) Serum cytokine profiles and their correlations with disease activity in Takayasu’s arteritis. Rheumatology (Oxford) 45:545–548
Ito I (1992) Medical treatment of Takayasu’s arteritis. Heart Vessels Suppl 7:133–137
Masmoudi S, Frikha I, Gdoura M, Zouari MH, Mnif J, Sahnoun Y (1992) Takayasu’s disease. Diagnostic criteria and therapeutic procedure. Ann Cardiol Angiol (Paris) 41:A55–A61
Hoffman GS (1996) Takayasu’s arteritis: lessons from the American National Institutes of Health experience. Int J Cardiol 54:S99–S102
Numano F (2002) Takayasu’s arteritis: clinical aspects. In: Hoffman GS, Wyand CM (eds) Inflammatory diseases of blood vessels. Marcel Dekker, New York, pp 455–466
Hoffman GS, Leavitt RY, Kerr GS, Rottern M, Sneller MC, Fauci AS (1994) Treatment of glucocorticoid-resistent or relapsing Takayasu arteritis with methotrexate. Arthritis Rheum 37:578–582
Della Rossa A, Tavoni A, Merlini G, Baldini C, Sebastiani M, Lombardi M, Neglia D, Bombardieri S (2005) Two Takayasu arteritis patients successfully treated with Infliximab: a potential disease-modifying agent? Rheumatology (Oxford) 44:1074–1075
Johnston SL, Lock RJ, Gompels MM (2002) Takayasu’s arteritis: a review. J Clin Pathol 55:481–486
Liang GC, Nemickas R, Madayag M (1989) Multiple percutaneous transluminal angioplasties and low dose methotrexate for Takayasu’s arteritis. J Rheumatol 16:1370–1373
Besson-Léaud I, Grenier N, Besson-Léaud M, Boniface C, Guillard LM (2001) Takayasu’s disease: interest in methotrexate for Takayasu’s arteritis. Arch Pediatr 8:724–727
Gutierrez-Urena MA, Molina JF, Garcia CO, Cuellar ML, Espinoza LR (1996) Pancytopenia secondary to methotrexate therapy in rheumatoid arthritis. Arthritis Rheum 39:272–276
Shelhamer JH, Volkman DJ, Parillo JE, Lawley TJ, Johnston MR, Fauci AS (1985) Takayasu’s arteritis and its therapy. Ann Intern Med 103:121–126
Talar-Williams C, Hijazi YM, Walther MM, Linehan WM, Hallahan CW, Lubensky I, Kerr GS, Hoffman GS, Fauci AS, Sneller MC (1996) Cyclophosphamide-induced cystitis and bladder cancer in patients with Wegener granulomatosis. Ann Intern Med 124:477–484
Valsakumar AK, Valappil UC, Jorapur V, Garg N, Nityanand S, Sinha N (2003) Role of immunosuppressive therapy on clinical, immunological, and angiographic outcome in active Takayasu’s arteritis. J Rheumatol 30:1793–1798
Horigome H, Kamoda T, Matsuy A (1999) Treatment of glucocorticoid-dependent Takayasu’s arteritis with cyclosporine. Med J Aust 170:566
Haberhauer G, Kittl EM, Dunky A, Feyertag J, Bauer K (2001) Beneficial effects of leflunomide in glucocorticoid- and methotrexate-resistant Takayasu’s arteritis. Clin Exp Rheumatol 19:477–478
Sollinger HW (1995) Mycophenolate mofetil for the prevention of acute rejection in primary cadaveric renal allograft recipients. US Renal Transplant Mycophenolate Mofetil Study Group. Transplantation 60:225–232
Kissin EY, Merkel PA (2003) Diagnostic imaging in Takayasu arteritis. Curr Opin Rheumatol 16:31–37
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Shinjo, S.K., Pereira, R.M.R., Tizziani, V.A.P. et al. Mycophenolate mofetil reduces disease activity and steroid dosage in Takayasu arteritis. Clin Rheumatol 26, 1871–1875 (2007). https://doi.org/10.1007/s10067-007-0596-z
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DOI: https://doi.org/10.1007/s10067-007-0596-z