Efficacy and safety of mycophenolate mofetil in the treatment of rheumatic disease-related interstitial lung disease: a narrative review

Article Details

Authors
Giulia Cassone MD, PhD, Marco Sebastiani MD, Caterina Vacchi MD, PhD, Gian Luca Erre MD, Carlo Salvarani MD, Andreina Manfredi MD, PhD

Article Type
Review

DOI
10.7573/dic.2020-8-8

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Abstract

Mycophenolate mofetil (MMF) is an antimetabolite with a potent inhibitory effect on proliferation of T and B lymphocytes used since the early 1990s for the prevention of acute allograft rejection after organ transplant. MMF is also widely used for the treatment of a variety of rheumatic diseases (RDs) and their pulmonary involvement. Interstitial lung disease (ILD) is a heterogeneous group of progressive fibrotic diseases of the lung, which is often secondary to RD and represents a major cause of morbidity and mortality. MMF is considered the main alternative to cyclophosphamide as a first-line agent to treat RD-related ILD or as possible maintenance therapy after cyclophosphamide, with a lower rate of side-effects. However, as for other immunosuppressive agents, the use of MMF in RD-ILD is supported by poor scientific evidence. In this narrative review, we describe the available data and recent advances on the effectiveness and safety of MMF for the treatment of ILD related to RD, including rheumatoid arthritis, systemic sclerosis, primary Sjögren syndrome, systemic lupus erythematosus, idiopathic inflammatory myopathies, undifferentiated connective tissue disease, interstitial pneumonia with autoimmune features and antineutrophil cytoplasmic antibody-associated vasculitis.

Keywords: connective tissue diseases, efficacy, interstitial lung disease, lung fibrosis, mycophenolate mofetil, rheumatic diseases, safety.

Citation: Cassone G, Sebastiani M, Vacchi C, Erre GL, Salvarani C, Manfredi A. Efficacy and safety of mycophenolate mofetil in the treatment of rheumatic disease-related interstitial lung disease: a narrative review. Drugs in Context 2021; 10: 2020-8-8. DOI: 10.7573/dic.2020-8-8

Contributions: All authors contributed equally to the preparation of this review. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: The authors declare that they have no conflicts of interest relevant to this manuscript. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2020/12/dic.2020-8-8-COI.pdf

Acknowledgements: None.

Funding declaration: There was no funding associated with the preparation of this article.

Copyright: Copyright © 2021 Cassone G, Sebastiani M, Vacchi C, Erre GL, Salvarani C, Manfredi A. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2021 Cassone G, Sebastiani M, Vacchi C, Erre GL, Salvarani C, Manfredi A. https://doi.org/10.7573/dic.2020-8-8. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/efficacy-and-safety-of-mycophenolate-mofetil-in-the-treatment-of-rheumatic-disease-related-interstitial-lung-disease:-a-narrative-review

Correspondence: Andreina Manfredi, Rheumatology Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100 Modena, Italy. andreina.manfredi@gmail.com

Provenance: Invited; externally peer reviewed.

Submitted: 31 August 2020; Accepted: 26 November 2020; Publication date: 15 January 2021.

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