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Inosine monophosphate dehydrogenase inhibition: mycophenolate mofetil

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Modern Immunosuppressives

Part of the book series: Milestones in Drug Therapy MDT ((MDT))

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Abstract

Over the past two decades, the development of new immunosuppressive drugs and the prevention of post-transplant infection have substantially improved the survival of transplanted patients and of organ allografts. However, the prevention of acute rejection and consequently of chronic allograft dysfunction, as well as that of long-term metabolic complications and malignancies, are still important issues. In this chapter, we will focus on mycophenolate mofetil, an antiproliferative agent with proven clinical efficacy in human organ transplantation and autoimmune diseases and a satisfactory safety profile.

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References

  1. Sayegh MH, Turka LA (1998) The role of T-cell costimulatory activation pathways in transplant rejection. N Engl J Med 338: 1813–1821

    Article  PubMed  CAS  Google Scholar 

  2. Allison AC, Eugui EM (1993) Immunosuppressive and other effects of mycophenolic acid and an ester prodrug, mycophenolate mofetil. Immunol Rev 136: 5–28

    Article  PubMed  CAS  Google Scholar 

  3. Natsumeda Y, Can S (1993) Human type I and II IMP dehydrogenase as targets. Ann N Y Acad Sci 696: 88–93

    Article  PubMed  CAS  Google Scholar 

  4. Sintchak MD, Fleming MA, Futer O, Raybuck SA, Chambers SP, Caron PR, Murcko MA, Wilson KP (1996) Structure and mechanism of inosine monophosphate dehydrogenase in complex with the immunosuppressant mycophenolic acid. Cell 85: 921–930

    Article  PubMed  Google Scholar 

  5. Bullingham RE, Nicholls AJ, Kamm BR (1998) Clinical pharmacokinetics of mycophenolate mofetil. Clin Pharmacokinet 34: 429–455

    Article  PubMed  CAS  Google Scholar 

  6. Sanquer S, Breil M, Baron C, Dahmane D, Astier A, Lang P (1998) Trough blood concentrations in long-term treatment with mycophenolate mofetil. Lancet 351: 1557

    Article  PubMed  CAS  Google Scholar 

  7. Yatscoff RW, Aspeslet LJ, Gallant HL (1998) Pharmacodynamic monitoring of immunosuppressive drugs. Clin Chem 44: 428–432

    PubMed  CAS  Google Scholar 

  8. Takahashi K, Ochiai T, Uchida K, Yasumura T, Ishibashi M, Suzuki S, Otsubo O, Isono K, Takagi H, Oka T et al (1995) Pilot study of mycophenolate mofetil (RS-61443) in the prevention of acute rejection following renal transplantation in Japanese patients. Transplant Proc 27: 1421–1424

    PubMed  CAS  Google Scholar 

  9. Hale MD, Nicholls AJ, Bullingham RES, Hene R, Hoitsma A, Squifflet JP, Weimar W, Vanrenterghem Y, Van de Woude FJ, Verpooten GA (1998) The pharmacokinetic-pharmacodynamic relationship for mycophenolate mofetil in renal transplantation. Clin Pharmacol Ther 64: 672–683

    Article  PubMed  CAS  Google Scholar 

  10. Shaw LM, Nicholls A, Hale M, Armstrong VW, Oellerich M, Yatscoff R, Morris RE, Holt DW, Venkataramanan R, Haley J et al (1998) Therapeutic monitoring of mycophenolic acid. A consensus panel report. Clin Biochem 31: 317–322

    Article  PubMed  CAS  Google Scholar 

  11. Sollinger HW, Deierhoi MH, Belzer FO, Diethelm AG, Kauffman RS (1992) RS-61443: a phase I clinical trial and pilot rescue study. Transplantation 53: 428–432

    Article  PubMed  CAS  Google Scholar 

  12. Sollinger HW for the USRenal Transplant Mycophenolate Mofetil Study Group (1995) Mycophenolate mofetil for the prevention of acute rejection in primary cadaveric renal allograft recipients. Transplantation 60: 225–232

    Article  Google Scholar 

  13. European Mycophenolate Mofetil Study Group (1995) Placebo-controlled study of mycophenolate mofetil combined with cyclosporin and corticosteroid for prevention of acute rejection. Lancet 345: 1321–1325

    Google Scholar 

  14. The Tricontinental Mycophenolate Mofetil Renal Transplantation Study Group (1996) A blinded, randomized clinical trial of mycophenolate mofetil for the prevention of acute rejection in cadaveric renal transplantation. Transplantation 61: 1029–1037

    Article  Google Scholar 

  15. Halloran P, Mathew T, Tomlanovich S, Groth C, Hooftman L, Barker C (1997) Mycophenolate mofetil in renal allograft recipients. A pooled efficacy analysis of three randomized, double-blind, clinical studies in prevention of rejection. Transplantation 63: 39–47

    Article  PubMed  CAS  Google Scholar 

  16. Neylan JF for the USRenal Transplant Mycophenolate Mofetil Study Group (1997) Immunosuppressive therapy in high-risk transplant patients. Dose-dependent efficacy of mycophenolate mofetil in African-American renal allograft recipients. Transplantation 64: 1277–1282

    Article  Google Scholar 

  17. Shapiro R, Jordan ML, Scantlebury VP, Vivas C, Marsh JW, McCauley J, Johnston J, Randhawa P, Irish W, Gritsch HA et al (1999) A prospective, randomized trial of tacrolimus/prednisone versus tacrolimus/prednisone/mycophenolate mofetil in renal transplant recipients. Transplantation 67: 411–415

    Article  PubMed  CAS  Google Scholar 

  18. Gruessner RW, Sutherland DE, Drangstveit MB, Wrenshall L, Humar A, Gruessner AC (1998) Mycophenolate mofetil in pancreas transplantation. Transplantation 66: 318–323

    Article  PubMed  CAS  Google Scholar 

  19. Odorico JS, Pirsch JD, Knechtle SJ, D’Alessandro AM, Sollinger HW (1998) A study comparing mycophenolate mofetil to azathioprine in simultaneous pancreas-kidney transplantation. Transplantation 66: 1751–1759

    Article  PubMed  CAS  Google Scholar 

  20. Kobashigawa J, Miller L, Renlund D, Mentzer R, Alderman E, Bourge R, Costanzo M, Eisen H, Dureau G, Ratkovec R et al (1998) A randomized active-controlled trial of mycophenolate mofetil in heart transplant recipients. Transplantation 66: 507–515

    Article  PubMed  CAS  Google Scholar 

  21. Eckhoff DE, McGuire BM, Frenette JR, Contreras JL, Hudson SL, Bynon JS (1998) Tacrolimus and mycophenolate mofetil combination therapy versus tacrolimus in adult liver transplantation. Transplantation 65: 180–187

    Article  PubMed  CAS  Google Scholar 

  22. Jain AB, Hamad I, Rakela J, Dodson F, Kramer D, Demetris J, McMichael J, Starzl TE, Fung JJ (1998) A prospective randomized trial of tacrolimus and prednisone versus tacrolimus, prednisone, and mycophenolate mofetil in primary adult liver transplant recipients: an interim report. Transplantation 66: 1395–1398

    Article  PubMed  CAS  Google Scholar 

  23. Ross DJ, Waters PF, Levine M, Kramer M, Ruzevich S, Kass RM (1998) Mycophenolate mofetil versus azathioprine immunosuppressive regimens after lung transplantation: preliminary experience. J Heart Lung Transplant 17: 768–774

    PubMed  CAS  Google Scholar 

  24. Tsakis AG, Weppler D, Khan MF, Koutouby R, Romero R, Viciana AL, Raskin J, Nery JR, Thompson J (1998) Mycophenolate mofetil as primary and rescue therapy in intestinal transplantation. Transplant Proc 30: 2677–2679

    Article  Google Scholar 

  25. The Mycophenolate Mofetil Acute Renal Rejection Study Group (1998) Mycophenolate mofetil for the treatment of a first acute renal allograft rejection. Transplantation 65: 235–241

    Google Scholar 

  26. The Mycophenolate Mofetil Renal Refractory Rejection Study Group (1996) Mycophenolate mofetil for the treatment of refractory, acute, cellular renal transplant rejection. Transplantation 61: 722–729

    Article  Google Scholar 

  27. Pascual M, Saidman S, Tolkoff-Rubin N, Williams WW, Mauiyyedi S, Duan JM, Farrell ML, Colvin RB, Cosimi AB, Delmonico FL (1998) Plasma exchange and tacrolimus-mycophenolate rescue for acute humoral rejection in kidney transplantation. Transplantation 66: 1460–1464

    Article  PubMed  CAS  Google Scholar 

  28. Mathew TH for the Tricontinental Mycophenolate Mofetil Renal Transplantation Study Group (1998) A blinded, long-term, randomized multicenter study of mycophenolate mofetil in cadaveric renal transplantation. Transplantation 65: 1450–1454

    Article  Google Scholar 

  29. USRenal Transplant Mycophenolate Mofetil Study Group (1999) Mycophenolate Mofetil in cadaveric renal transplantation. Amer J Kidney Dis 34: 296–303

    Article  Google Scholar 

  30. Glicklich D, Gupta B, Schurter-Frey G, Greenstein SM, Schechner RS, Tellis VA (1998) Chronic renal allograft rejection: no response to mycophenolate mofetil. Transplantation 66: 398–399

    Article  PubMed  CAS  Google Scholar 

  31. Grinyo JM, Gil-Vernet S, Seron D, Hueso M, Fulladosa X, Cruzado JM, Moreso F, Fernandez A, Torras J, Riera L et al (1998) Primary immunosuppression with mycophenolate mofetil and antithymocyte globulin for kidney transplant recipients of a suboptimal kidney. Nephrol Dialysis Transplant 13: 2601–2604

    Article  CAS  Google Scholar 

  32. Zanker B, Schneeberger H, Rothenpieler U, Hillebrand G, Illner WD, Theodorakis I, Stangl M, Land W (1998) Mycophenolate mofetil-based, cyclosporine-free induction and maintenance immunosuppression: first-3-months analysis of efficacy and safety in two cohorts of renal allograft recipients. Transplantation 66: 44–49

    Article  PubMed  CAS  Google Scholar 

  33. Weir MR, Anderson L, Fink JC, Gabregiorgish K, Schweitzer EJ, Hoehn-Saric E, Klassen DK, Cangro CB, Johnson LB, Kuo PC et al (1997) A novel approach to the treatment of chronic allograft nephropathy. Transplantation 64: 1706–1710

    Article  PubMed  CAS  Google Scholar 

  34. Ducloux D, Fournier V, Bresson-Vautrin C, Rebibou JM, Billerey C, Saint-Hillier Y, Chalopin JM (1998) Mycophenolate mofetil in renal transplant recipients with cyclosporine-associated nephrotoxicity: a preliminary report. Transplantation 65: 1504–1506

    Article  PubMed  CAS  Google Scholar 

  35. Hueso M, Boyer J, Seron D, Gil-Vernet S, Sabate I, Fulladosa X, Ramos R, Coll O, Alsina J, Grinyo JM (1998) Low-dose cyclosporine and mycophenolate mofetil in renal allograft recipients with suboptimal function. Transplantation 66: 1727–1731

    Article  PubMed  CAS  Google Scholar 

  36. Birkeland SA (1998) Steroid-free immunosuppression after kidney transplantation with antithymocyte globulin induction and cyclosporine and mycophenolate mofetil maintenance therapy. Transplantation 66: 1207–1210

    Article  PubMed  CAS  Google Scholar 

  37. Lebranchu Y for the M 55002 Study Group (1999) Comparison of 2 corticosteroid regimens in combination with MMF and cyclosporine for prevention of acute allograft rejection: 12 month results of a double-blind, randomized, multi-center study. Transplant Proc 31: 249–250

    Article  Google Scholar 

  38. Basara N, Blau WI, Romer E, Rudolphi M, Bischoff M, Kirsten D, Sanchez H, Gunzelmann S, Fauser AA (1998) Mycophenolate mofetil for the treatment of acute and chronic GVHD in bone marrow transplant patients. Bone Marrow Transplant 22: 61–65

    Article  PubMed  CAS  Google Scholar 

  39. Bornhauser M, Schuler U, Porksen G, Naumann R, Geissler G, Thiede C, Schwerdtfeger R, Ehninger G, Thiede HM (1999) Mycophenolate mofetil and cyclosporine as graft-versus-host disease prophylaxis after allogeneic blood stem cell transplantation. Transplantation 67: 499–504

    Article  PubMed  CAS  Google Scholar 

  40. Jacobs F, Mamzer-Bruneel MF, Skhiri H, Thervet E, Legendre C, Kreis H (1997) Safety of the mycophenolate mofetil-allopurinol combination in kidney transplant recipients with gout. Transplantation 64: 1087–1088

    Article  PubMed  CAS  Google Scholar 

  41. Schmid C, Garritsen HS, Kelsch R, Cassens U, Baba HA, Sibrowski W, Scheid HH (1998) Suppression of panel-reactive antibodies by treatment with mycophenolate mofetil. Thorac Cardiovasc Surg 46: 161–162

    Article  PubMed  CAS  Google Scholar 

  42. Kimball JA, Pescovitz MD, Book BK, Norman DJ (1995) Reduced human IgG anti-ATGAM antibody formation in renal transplant recipients receiving mycophenolate mofetil. Transplantation 60: 1379–1383

    Article  PubMed  CAS  Google Scholar 

  43. Broeders N, Wissing M, Crusiaux A, Kinnaert P, Vereerstraeten P, Abramowicz D (1998) Mycophenolate mofetil together with cyclosporin A prevents anti-OKT3 antibody response in kidney transplant recipients. J Amer Soc Nephrol 9: 1521–1525

    CAS  Google Scholar 

  44. Oz HS, Hughes WT (1997) Novel anti-pneumocystis carinii effects of the immunosuppressant mycophenolate mofetil in contrast to provocative effects of tacrolimus, sirolimus, and dexamethasone. J Infect Dis 175: 901–904

    Article  PubMed  CAS  Google Scholar 

  45. Glicklich D, Acharya A (1998) Mycophenolate mofetil therapy for lupus nephritis refractory to intravenous cyclophosphamide. Amer J Kidney Dis 32: 318–322

    Article  CAS  Google Scholar 

  46. Briggs WA, Choi MJ, Scheel PJ (1998) Successful mycophenolate mofetil treatment of glomerular disease. Amer J Kidney Dis 31: 213–217

    Article  CAS  Google Scholar 

  47. Neurath MF, Wanitschke R, Peters M, Krummenauer F, Meyer zum Buschenfelde KH, Schlaak JF (1999) Randomised trial of mycophenolate mofetil versus azathioprine for treatment of chronic active Crohn’s disease. Gut 44: 625–628

    Article  PubMed  CAS  Google Scholar 

  48. Enk AH, Knop J (1999) Mycophenolate is effective in the treatment of pemphigus vulgaris. Arch Dermatol 135: 54–56

    Article  PubMed  CAS  Google Scholar 

  49. Sarmiento JM, Munn SR, Paya CV, Velosa JA, Nguyen JH (1998) Is cytomegalovirus infection related to mycophenolate mofetil after kidney transplantation? Clin Transplant 12: 371–374

    PubMed  CAS  Google Scholar 

  50. Neyts J, Andrei G, De Clercq E (1998) The novel immunosuppressive agent mycophenolate mofetil markedly potentiates the antiherpesvirus activities of acyclovir, ganciclovir, penciclovir in vitro and in vivo. Antimicrob Agents Chemother 42: 216–222

    PubMed  CAS  Google Scholar 

  51. Mignat C (1997) Clinically significant drug interactions with new immunosuppressive agents. Drug Safety 16: 267–278

    Article  PubMed  CAS  Google Scholar 

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© 2001 Springer Basel AG

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Legendre, C., Thervet, E. (2001). Inosine monophosphate dehydrogenase inhibition: mycophenolate mofetil. In: Schuurman, HJ., Feutren, G., Bach, JF. (eds) Modern Immunosuppressives. Milestones in Drug Therapy MDT. Birkhäuser, Basel. https://doi.org/10.1007/978-3-0348-8352-8_5

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  • DOI: https://doi.org/10.1007/978-3-0348-8352-8_5

  • Publisher Name: Birkhäuser, Basel

  • Print ISBN: 978-3-0348-9530-9

  • Online ISBN: 978-3-0348-8352-8

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