Sanford Mark, Keating Gillian M
Wolters Kluwer Health | Adis, Auckland, New Zealand.
Drugs. 2008;68(17):2505-33. doi: 10.2165/0003495-200868170-00007.
Enteric-coated mycophenolate sodium (Myfortic) is a reversible, noncompetitive inosine monophosphate dehydrogenase (IMPDH) inhibitor that is approved in the EU, the US and in other countries worldwide for immunosuppressive prophylaxis against graft rejection in adult renal transplant patients.Enteric-coated mycophenolate sodium has a delayed absorption from the gastrointestinal (GI) tract in comparison with mycophenolate mofetil, thereby potentially reducing GI adverse events. In randomized, double-blind trials of de novo and maintenance immunosuppressive therapy in renal transplant patients receiving ciclosporin emulsion-based regimens, enteric-coated mycophenolate sodium was as effective as mycophenolate mofetil in preventing renal graft rejection. Enteric-coated mycophenolate sodium provides an alternative to mycophenolate mofetil in the treatment of de novo renal transplant recipients and ongoing research should indicate whether an intensified dosage regimen can further improve clinical outcomes. Renal transplant patients receiving mycophenolate mofetil maintenance immunosuppressive therapy may be switched to enteric-coated mycophenolate sodium without compromising efficacy.The general tolerability profile of enteric-coated mycophenolate sodium was similar to that of mycophenolate mofetil. Patients selected for GI intolerance associated with mycophenolate mofetil treatment showed reductions in GI symptoms when switched to enteric-coated mycophenolate sodium, while in unselected patients in comparative trials, there was no difference between enteric-coated mycophenolate sodium and mycophenolate mofetil in GI tolerability. Enteric-coated mycophenolate sodium provides an alternative to mycophenolate mofetil in renal transplant patients receiving mycophenolate mofetil maintenance immunosuppressive therapy who have GI symptoms that have not responded to other management strategies, because they may experience improvement if switched to enteric-coated mycophenolate sodium. Thus, in association with ciclosporin-based regimens, enteric-coated mycophenolate sodium is a valuable treatment option for immunosuppressive prophylaxis in adult renal transplant recipients.
肠溶包衣的吗替麦考酚酯钠（迈弗通）是一种可逆的、非竞争性的肌苷单磷酸脱氢酶（IMPDH）抑制剂，在欧盟、美国及世界其他国家被批准用于成年肾移植患者预防移植排斥反应的免疫抑制治疗。与吗替麦考酚酯相比，肠溶包衣的吗替麦考酚酯钠从胃肠道（GI）的吸收延迟，从而有可能减少胃肠道不良事件。在接受基于环孢素乳剂方案的肾移植患者进行的初治和维持免疫抑制治疗的随机双盲试验中，肠溶包衣的吗替麦考酚酯钠在预防肾移植排斥反应方面与吗替麦考酚酯同样有效。肠溶包衣的吗替麦考酚酯钠为初治肾移植受者的治疗提供了吗替麦考酚酯的一种替代选择，正在进行的研究应能表明强化剂量方案是否能进一步改善临床结局。接受吗替麦考酚酯维持免疫抑制治疗的肾移植患者可改用肠溶包衣的吗替麦考酚酯钠，而不会影响疗效。肠溶包衣的吗替麦考酚酯钠的总体耐受性与吗替麦考酚酯相似。因吗替麦考酚酯治疗出现胃肠道不耐受的患者改用肠溶包衣的吗替麦考酚酯钠后胃肠道症状减轻，而在比较试验中的未选患者中，肠溶包衣的吗替麦考酚酯钠和吗替麦考酚酯在胃肠道耐受性方面无差异。对于接受吗替麦考酚酯维持免疫抑制治疗且胃肠道症状对其他管理策略无反应的肾移植患者，肠溶包衣的吗替麦考酚酯钠提供了吗替麦考酚酯的一种替代选择，因为改用肠溶包衣的吗替麦考酚酯钠后他们可能会有所改善。因此，与基于环孢素的方案联合使用时，肠溶包衣的吗替麦考酚酯钠是成年肾移植受者免疫抑制预防的一种有价值的治疗选择。
