Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India.
Clin Rheumatol. 2010 Mar;29(3):329-32. doi: 10.1007/s10067-009-1333-6.
Mycophenolate mofetil (MMf) has recently been reported as a useful alternative immunosuppressive drug in autoimmune diseases. There is paucity of literature on its use in Takayasu's arteritis (TA). The aim of this study was to assess the safety and efficacy of MMf in Asian Indian patients with Takayasu's arteritis. Records of 21 consecutive patients with TA on treatment with oral MMF attending our centre from January 2005 to August 2008 were studied. The clinical, laboratory and angiography findings were noted and disease activity assessment was done using Indian Takayasu's arteritis activity score (ITAS) and physician's global observation score at baseline and last follow-up. Eleven patients were on steroids alone at baseline while ten patients had received azathioprine prior to administration of mycophenolate. The mean duration of follow-up on mycophenolate was 9.6 (+/-6.4) months. Nineteen patients (90%) received mycophenolate due to active disease, while in the other two patients, it was given to facilitate steroid tapering. Mycophenolate had to be discontinued in one patient due to skin rash. At the last visit, all the remaining 20 patients who continued mycophenolate had improvement in disease activity as evident by the drop in median ITAS [7 (range 0-19) versus 1 (range 0-7); p=0.001]. A similar trend was noted in laboratory markers of inflammation with a reduction in mean Erythrocyte Sedimentation Rate (ESR) (68+/-36.5 versus 43.2+/-34 mm/first hour; p=0.003) and mean C - Reactive protein (CRP) (31+/-46.7 versus 17.3+/-23.9 mg/L; p=1.00). All patients received concomitant steroids, but there was a significant decrease in steroid dosage from 36 (+/-16) mg/day at baseline to 19 (+/-14) mg/day at last follow-up (p<0.001). This study is the largest series till date establishing the use of mycophenolate as a safe and effective steroid-sparing immunosuppressant in Takayasu's arteritis.
霉酚酸酯（MMF）最近被报道为一种在自身免疫性疾病中有用的替代免疫抑制剂。关于其在大动脉炎（TA）中的应用，文献报道甚少。本研究的目的是评估霉酚酸酯在印度裔 TA 患者中的安全性和疗效。我们研究了 2005 年 1 月至 2008 年 8 月期间在我们中心接受口服 MMF 治疗的 21 例连续 TA 患者的记录。记录了临床、实验室和血管造影结果，并在基线和最后随访时使用印度大动脉炎活动评分（ITAS）和医生总体观察评分进行疾病活动评估。基线时有 11 例患者单独使用类固醇，而在开始使用霉酚酸酯之前，有 10 例患者接受了硫唑嘌呤治疗。霉酚酸酯的平均随访时间为 9.6（+/-6.4）个月。19 例（90%）患者因疾病活动而接受霉酚酸酯治疗，而另外 2 例患者接受霉酚酸酯治疗是为了便于减少类固醇剂量。由于皮疹，有 1 例患者不得不停用霉酚酸酯。在最后一次就诊时，继续使用霉酚酸酯的 20 例患者中，所有人的疾病活动均有改善，这一点从中位数 ITAS 的下降中可以明显看出[7（范围 0-19）与 1（范围 0-7）；p=0.001]。炎症的实验室标志物也有类似的趋势，红细胞沉降率（ESR）均值（68+/-36.5 与 43.2+/-34mm/首小时；p=0.003）和 C 反应蛋白（CRP）均值（31+/-46.7 与 17.3+/-23.9mg/L；p=1.00）均下降。所有患者均接受了皮质类固醇治疗，但最后一次随访时皮质类固醇剂量从基线时的 36（+/-16）mg/天显著减少至 19（+/-14）mg/天（p<0.001）。这项研究是迄今为止最大的系列研究，证明霉酚酸酯是一种安全有效的、可以减少类固醇用量的免疫抑制剂，可用于治疗大动脉炎。
