Mycophenolate mofetil therapy in Taiwanese myasthenia gravis

Background: Mycophenolate mofetil (MM) has been successfully used for the treatment of immune-mediated diseases, including myasthenia gravis (MG). We compare our experience treating Taiwanese myasthenic patients with MM to analogous Caucasian series. Methods: From October 2003 to April 2008, we treated 6 myasthenic patients with MM for at least one year at Shin Kong Wu Ho-Su Memorial Hospital. The inclusion criteria for MM treatment included poor responses to previous treatment or intolerance to the side effects of previous immunosuppressive therapies. The MM was given orally with a dose of 1 g twice per day. Mandatory surveillance laboratory studies and clinical assessment were performed periodically. Results: Three of our six patients responded well to MM treatment in terms of improvement in MG score and achievement of minimal manifestation status. The fourth patient showed delayed onset of response 12 months after commencement of MM treatment. Steroid-sparing effect could be demonstrated in 4 patients. The overall response rate (66%) was slightly lower than that reported for Caucasian series. Clinical improvement generally began in the second to four months. MM was well tolerated. Conclusion: MM was well tolerated by our six treated patients. Although the clinical response was modest, MM has its advantage of a relatively rapid response onset and steroid-sparing effect.