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. 2023 Nov 9:10:1254747.
doi: 10.3389/fmed.2023.1254747. eCollection 2023.

Mycophenolate mofetil in giant cell arteritis

Anne Pankow  1   2 , Sena Sinno  2 , Thorsten Derlin  3 , Marcus Hiss  2 , Annette D Wagner  2
Affiliations

Mycophenolate mofetil in giant cell arteritis

Anne Pankow et al. Front Med (Lausanne). .

Abstract

Introduction: Giant cell arteritis (GCA) is a systemic granulomatous vasculitis affecting the large arteries. Abnormal lymphocyte function has been noted as a pathogenic factor in GCA. Mycophenolate mofetil (MMF) inhibits inosine monophosphate dehydrogenase and is therefore a highly lymphocyte-specific immunosuppressive therapy. We aimed to assess the efficacy of MMF for inducing remission in GCA.

Methods: Seven patients (5 female, 2 male) with GCA under therapy with MMF and who were treated at the outpatient clinic for rare inflammatory systemic diseases at Hannover Medical School between 2010 and 2023 were retrospectively included in the study. All patients underwent duplex sonography, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), magnetic resonance imaging (MRI), and/or biopsy to confirm the diagnosis. The primary endpoints were the number of recurrences, CRP levels at 3-6 and 6-12 months, and the period of remission.

Results: All patients in this case series showed inflammatory activity of the arterial vessels in at least one of the imaging modalities: duplex sonography (n = 5), 18F-FDG PET (n = 5), MRI (n = 6), and/or biopsy (n = 5). CRP levels of all patients decreased at the measurement time points 3-6 months, and 6-9 months after initiation of therapy with MMF compared with CRP levels before MMF therapy. All patients with GCA in this case series achieved disease remission.

Discussion: The results of the present case series indicate that MMF is an effective therapy in controlling disease activity in GCA, which should be investigated in future randomized controlled trials.

Keywords: Mycophenolate mofetil; case series; giant cell arteritis; imaging; vasculitis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
CRP values at the beginning of therapy with MMF and in the course of therapy.
Figure 2
Figure 2
(A) 08/17 Maximum-intensity projection (MIP) 18F-FDG PET image showing active large vessel vasculitis in a 3-year-old male patient. (B–G) Transversal fused PET/CT and PET images showing high inflammatory arterial wall signal in the aortic arch (B,C) and the thoracic (D,E) and abdominal aorta (F,G). (H–N) 12/2017 Corresponding PET images after treatment showing markedly reduced signal within arterial walls.
See this image and copyright information in PMC

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