Calvo N, Sanchez-Fructuoso A I, Conesa J, Moreno A, Barrientos A
Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain.
Transplant Proc. 2006 Oct;38(8):2396-7. doi: 10.1016/j.transproceed.2006.08.085.
The introduction of mycophenolate mofetil (MMF) was an important advance in immunosuppressive therapy, although its use is limited by adverse gastrointestinal events. Enteric-coated mycophenolate sodium (EC-MPS; myfortic) has been developed to avoid these side effects. Recent clinical trials have demonstrated that EC-MPS is a safe drug in both de novo and maintenance renal transplant patients. In this prospective study, therapeutically equivalent doses of EC-MPS were administered to 39 stable kidney transplant patients receiving MMF. After 3 months of treatment with EC-MPS the incidence of adverse gastrointestinal events was lower (15.8% of the patients). There were higher levels of mycophenolic acid after conversion to EC-MPS, probably due to better absorption. These factors allowed decreased doses and levels of calcineurin inhibitors without increasing the risk of graft rejection. At 3 months postconversion, serum creatinine improved from the mean baseline value of 1.83 +/- 0.12 mg/dL to 1.70 +/- 0.10 mg/dL. In conclusion, EC-MPS was well tolerated in maintenance renal transplant patients with adverse gastrointestinal events secondary to MMF.
霉酚酸酯（MMF）的引入是免疫抑制治疗的一项重要进展，尽管其使用受到胃肠道不良事件的限制。肠溶包衣的霉酚酸钠（EC-MPS；米芙）已被研发出来以避免这些副作用。近期的临床试验表明，EC-MPS在初次肾移植和维持性肾移植患者中都是一种安全的药物。在这项前瞻性研究中，给39名接受MMF治疗的稳定肾移植患者给予治疗等效剂量的EC-MPS。在用EC-MPS治疗3个月后，胃肠道不良事件的发生率较低（占患者的15.8%）。转换为EC-MPS后，霉酚酸水平较高，可能是由于吸收更好。这些因素使得钙调神经磷酸酶抑制剂的剂量和水平得以降低，而不增加移植排斥的风险。转换后3个月时，血清肌酐从平均基线值1.83±0.12mg/dL改善至1.70±0.10mg/dL。总之，对于因MMF继发胃肠道不良事件的维持性肾移植患者，EC-MPS耐受性良好。
