吗替麦考酚酯在重症肌无力患者中能安全减量吗？一项回顾性多中心分析。
Can mycophenolate mofetil be tapered safely in myasthenia gravis? A retrospective, multicenter analysis.
作者信息
Hobson-Webb Lisa D, Hehir Michael, Crum Brian, Visser Amy, Sanders Donald, Burns Ted M
机构信息
Department of Neurology, Duke University Medical Center, DUMC 3403, Durham, North Carolina, 27710, USA.
Department of Neurosciences, University of Vermont College of Medicine, Burlington, Vermont, USA.
出版信息
Muscle Nerve. 2015 Aug;52(2):211-5. doi: 10.1002/mus.24694. Epub 2015 Jun 18.
INTRODUCTION
Mycophenolate mofetil (MMF) is frequently used to treat myasthenia gravis, but there is little information to guide clinicians on the safety of reducing the dose in well-controlled patients.
METHODS
This retrospective chart review at 3 institutions identified 92 patients who had undergone MMF taper after achieving either pharmacologic remission or minimal manifestations status. Statistical analysis was performed to assess differences in patient characteristics between patients who had successfully tapered MMF and those who relapsed.
RESULTS
Of 92 patients undergoing a taper, 30 relapsed. The relapses were mild, transient, and usually responded to increased MMF dose. MG crisis did not occur. The mean dose at time of relapse was 888 mg/day. Patients with relapses were tapered more quickly (8.4 vs. 62.4 months).
CONCLUSIONS
Tapering MMF appears safe after years of disease stability. Reducing the dose at a dose of only 500 mg/day every 12 months is recommended.
引言
霉酚酸酯（MMF）常用于治疗重症肌无力，但关于在病情控制良好的患者中降低剂量的安全性，可供临床医生参考的信息较少。
方法
这项在3家机构进行的回顾性病历审查，确定了92例在达到药物缓解或最小表现状态后进行MMF减量的患者。进行统计分析以评估成功减量MMF的患者与复发患者之间的患者特征差异。
结果
在92例进行减量的患者中，30例复发。复发症状轻微、短暂，通常通过增加MMF剂量得到缓解。未发生重症肌无力危象。复发时的平均剂量为888毫克/天。复发患者的减量速度更快（8.4个月对62.4个月）。
结论
在疾病稳定多年后，逐渐减少MMF剂量似乎是安全的。建议每12个月以仅500毫克/天的剂量减少剂量。
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