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. 2024 Oct 28;24(1):537.
doi: 10.1186/s12890-024-03361-7.

Usefulness of monitoring mycophenolic acid exposure in systemic sclerosis-related interstitial lung disease: a retrospective cohort study

Jules Milesi  1   2 , Emmanuelle Sampol  3 , Audrey Benyamine  4 , Shani Diai  5 , Benjamin Coiffard  6   7 , Ana Nieves  6 , Brigitte Granel  4 , Martine Reynaud-Gaubert  6   7 , Julien Bermudez  6   7
Affiliations

Usefulness of monitoring mycophenolic acid exposure in systemic sclerosis-related interstitial lung disease: a retrospective cohort study

Jules Milesi et al. BMC Pulm Med. .

Abstract

Background: Systemic sclerosis-related interstitial lung disease (SSc-ILD) represents a significant cause of morbidity and mortality in Systemic Sclerosis (SSc). Mycophenolate mofetil (MMF) is currently the first line treatment for SSc-ILD. There is no recommendation on the dosage of mycophenolic acid (MPA) blood concentrations, so we aimed to study the correlation between MPA exposure and respiratory outcomes in this population.

Methods: We conducted a retrospective cohort study of SSc-ILD patients treated with MMF in our center. According to our policy, a complete patient evaluation was performed approximately one year after MMF initiation, during which the mycophenolic acid (MPA) residual rate (RR) was measured. We analyzed the association between RR and changes in forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLCO) over time.

Results: Forty-three SSc-ILD patients were included. Patients with higher RR levels (≥ 1.5 mg/L) had a significantly better FVC evolution with a higher proportion of stabilization and lower proportion of FVC decrease (p = 0.024). RR above 1.5 mg/L was a predictive factor of reduced FVC decline compared with lower RR levels adjusting for MMF dose and duration of MMF exposure (p = 0.008). There was no difference regarding DLCO outcome.

Conclusion: Our study suggests that optimal MPA exposure, as indicated by RR levels, may better protect against FVC decline in SSc-ILD patients treated with MMF. Routine monitoring of MPA exposure could be beneficial in optimizing treatment outcomes. Prospective, multicenter studies are needed to further explore the relationship between MPA exposure and clinical outcomes in SSc-ILD.

Keywords: Connective tissue diseases; Interstitial lung disease; Mycophenolic acid; Pharmacology; Scleroderma.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Pearson correlation between mycophenolic acid residual (MPA) rate and Mycophenolate Mofetil (MMF) dose
Fig. 2
Fig. 2
Longitudinal Plot of mean FVC evolution depending on mycophenolic acid residual rate
See this image and copyright information in PMC

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