Lim A K H, Donnan G, Chambers B, Ierino F L
Department of Nephrology, Austin Health, Melbourne, Victoria, Australia.
Intern Med J. 2007 Jan;37(1):55-9. doi: 10.1111/j.1445-5994.2006.01222.x.
Severe autoimmune myasthenia gravis is difficult to manage and may require immunosuppression with cyclosporine. However, cyclosporine dependency is associated with the risk of nephrotoxicity. Mycophenolate mofetil is a non-nephrotoxic alternative which should be considered to rescue cyclosporine-dependent, severe myasthenia gravis sufferers with renal impairment from progression to end-stage renal failure. However, the evidence is limited and studies have not assessed the outcome of a direct substitution in these cyclosporine-dependent patients. We study three such patients who successfully converted to mycophenolate mofetil, and briefly examine the evidence behind this option. We believe that total cyclosporine withdrawal is feasible, but strongly recommend overlapping mycophenolate mofetil treatment with cyclosporine.
重度自身免疫性重症肌无力难以治疗，可能需要使用环孢素进行免疫抑制。然而，对环孢素的依赖与肾毒性风险相关。霉酚酸酯是一种无肾毒性的替代药物，对于那些依赖环孢素、患有重症肌无力且有肾功能损害、有发展为终末期肾衰竭风险的患者，应考虑使用该药进行救治。然而，证据有限，且研究尚未评估在这些依赖环孢素的患者中直接换药的结果。我们研究了三名成功转换为使用霉酚酸酯的此类患者，并简要探讨了这一选择背后的证据。我们认为完全停用环孢素是可行的，但强烈建议霉酚酸酯治疗与环孢素重叠使用。
