Clinical Rheumatology

, Volume 26, Issue 11, pp 1871–1875 | Cite as

Mycophenolate mofetil reduces disease activity and steroid dosage in Takayasu arteritis

  • Samuel K. Shinjo
  • Rosa M. R. Pereira
  • Vivian A. P. Tizziani
  • Ari S. Radu
  • Maurício Levy-Neto
Original Article

Abstract

Mycophenolate mofetil (MMF) has recently been reported as a useful alternative immunosuppressive drug in autoimmune diseases including in Takayasu arteritis (TA). The aim of this study was to verify the efficacy and tolerability of MMF administration in controlling TA disease activity and allowing glucocorticosteroid reduction. Ten consecutive active TA patients followed at the Vasculitis Clinic were enrolled from January 2003 to 2006 and received oral MMF (2 g/day) for an average of 23.3 months. Disease activity assessed using the National Institutes of Health criteria, clinical features, and inflammatory laboratory findings were evaluated. Five patients had received at least one immunosuppressive drug before administration of MMF (four methotrexate, two azathioprine, and one chlorambucil) but had not achieved clinical and laboratory remission. The other five patients received MMF as their first immunosuppressive drug because of an important disease flare during steroid dose reduction. Clinical activity disappeared in all patients with MMF therapy, except in one patient who abandoned the study because of an important headache, attributed to the drug. Moreover, the MMF therapy allowed significant tapering of the prednisone dose in the rest of the nine patients (24.5 ± 17.1 vs 5.8 ± 7.8 mg/day; p = 0.0019). Reinforcing this finding, a significant reduction in inflammatory laboratory parameters, erythrocyte sedimentation rate (24.7 ± 15.5 vs 12.8 ± 10.8 mm/h; p = 0.036) and C-reactive protein (24.0 ± 14.9 vs 11.2 ± 10.7 mg/l; p = 0.0167), was observed. In summary, MMF therapy reduced clinical and laboratory parameters of TA disease activity, suggesting that this drug is a promising immunosuppressive drug, particularly in refractory cases and as a steroid-sparing agent.

Keywords

Glucocorticosteroid Immunosuppressive drug Mycophenolate mofetil Takayasu Arteritis Treatment 

References

  1. 1.
    Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, Hoffman GS (1994) Takayasu arteritis. Ann Intern Med 120:919–929PubMedGoogle Scholar
  2. 2.
    Hoffman GS, Ahmed AE (1998) Surrogate markers of disease activity in patients with Takayasu’s arteritis. A preliminary report from The International Network for the Study of the Systemic Vasculitides (INSSYS). Int J Cardiol 66:S191–S194PubMedCrossRefGoogle Scholar
  3. 3.
    Daina E, Schieppati A, Remuzzi G (1999) Mycophenolate mofetil for the treatment of Takayasu arteritis: report of three cases. Ann Intern Med 130:422–426PubMedGoogle Scholar
  4. 4.
    Hoffman GS, Merkel PA, Brasington RD, Lenschow DJ, Liang P (2004) Anti-tumor necrosis factor therapy in patients with difficult to treat Takayasu arteritis. Arthritis Rheum 50:2296–2304PubMedCrossRefGoogle Scholar
  5. 5.
    Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM, Fauci AS, Leavitt RY, Lie JT, Lightfoot RW Jr et al (1990) The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 33:1129–1334PubMedCrossRefGoogle Scholar
  6. 6.
    Hata A, Noda M, Moriwaki R, Numano F (1996) Angiographic findings of Takayasu arteritis: new classification. Int J Cardiol 54:S155–S163PubMedCrossRefGoogle Scholar
  7. 7.
    Park MC, Lee SW, Park YB, Chung NS, Lee SK (2005) Clinical characteristics and outcomes of Takayasu’s arteritis: analysis of 108 patients using standardized criteria for diagnosis, activity assessment, and angiographic classification. Scand J Rheumatol 34:284–292PubMedCrossRefGoogle Scholar
  8. 8.
    Park MC, Lee WS, Park YB, Lee SK (2006) Serum cytokine profiles and their correlations with disease activity in Takayasu’s arteritis. Rheumatology (Oxford) 45:545–548CrossRefGoogle Scholar
  9. 9.
    Ito I (1992) Medical treatment of Takayasu’s arteritis. Heart Vessels Suppl 7:133–137PubMedCrossRefGoogle Scholar
  10. 10.
    Masmoudi S, Frikha I, Gdoura M, Zouari MH, Mnif J, Sahnoun Y (1992) Takayasu’s disease. Diagnostic criteria and therapeutic procedure. Ann Cardiol Angiol (Paris) 41:A55–A61Google Scholar
  11. 11.
    Hoffman GS (1996) Takayasu’s arteritis: lessons from the American National Institutes of Health experience. Int J Cardiol 54:S99–S102PubMedCrossRefGoogle Scholar
  12. 12.
    Numano F (2002) Takayasu’s arteritis: clinical aspects. In: Hoffman GS, Wyand CM (eds) Inflammatory diseases of blood vessels. Marcel Dekker, New York, pp 455–466Google Scholar
  13. 13.
    Hoffman GS, Leavitt RY, Kerr GS, Rottern M, Sneller MC, Fauci AS (1994) Treatment of glucocorticoid-resistent or relapsing Takayasu arteritis with methotrexate. Arthritis Rheum 37:578–582PubMedCrossRefGoogle Scholar
  14. 14.
    Della Rossa A, Tavoni A, Merlini G, Baldini C, Sebastiani M, Lombardi M, Neglia D, Bombardieri S (2005) Two Takayasu arteritis patients successfully treated with Infliximab: a potential disease-modifying agent? Rheumatology (Oxford) 44:1074–1075CrossRefGoogle Scholar
  15. 15.
    Johnston SL, Lock RJ, Gompels MM (2002) Takayasu’s arteritis: a review. J Clin Pathol 55:481–486PubMedGoogle Scholar
  16. 16.
    Liang GC, Nemickas R, Madayag M (1989) Multiple percutaneous transluminal angioplasties and low dose methotrexate for Takayasu’s arteritis. J Rheumatol 16:1370–1373PubMedGoogle Scholar
  17. 17.
    Besson-Léaud I, Grenier N, Besson-Léaud M, Boniface C, Guillard LM (2001) Takayasu’s disease: interest in methotrexate for Takayasu’s arteritis. Arch Pediatr 8:724–727PubMedCrossRefGoogle Scholar
  18. 18.
    Gutierrez-Urena MA, Molina JF, Garcia CO, Cuellar ML, Espinoza LR (1996) Pancytopenia secondary to methotrexate therapy in rheumatoid arthritis. Arthritis Rheum 39:272–276PubMedCrossRefGoogle Scholar
  19. 19.
    Shelhamer JH, Volkman DJ, Parillo JE, Lawley TJ, Johnston MR, Fauci AS (1985) Takayasu’s arteritis and its therapy. Ann Intern Med 103:121–126PubMedGoogle Scholar
  20. 20.
    Talar-Williams C, Hijazi YM, Walther MM, Linehan WM, Hallahan CW, Lubensky I, Kerr GS, Hoffman GS, Fauci AS, Sneller MC (1996) Cyclophosphamide-induced cystitis and bladder cancer in patients with Wegener granulomatosis. Ann Intern Med 124:477–484PubMedGoogle Scholar
  21. 21.
    Valsakumar AK, Valappil UC, Jorapur V, Garg N, Nityanand S, Sinha N (2003) Role of immunosuppressive therapy on clinical, immunological, and angiographic outcome in active Takayasu’s arteritis. J Rheumatol 30:1793–1798PubMedGoogle Scholar
  22. 22.
    Horigome H, Kamoda T, Matsuy A (1999) Treatment of glucocorticoid-dependent Takayasu’s arteritis with cyclosporine. Med J Aust 170:566PubMedGoogle Scholar
  23. 23.
    Haberhauer G, Kittl EM, Dunky A, Feyertag J, Bauer K (2001) Beneficial effects of leflunomide in glucocorticoid- and methotrexate-resistant Takayasu’s arteritis. Clin Exp Rheumatol 19:477–478PubMedGoogle Scholar
  24. 24.
    Sollinger HW (1995) Mycophenolate mofetil for the prevention of acute rejection in primary cadaveric renal allograft recipients. US Renal Transplant Mycophenolate Mofetil Study Group. Transplantation 60:225–232PubMedCrossRefGoogle Scholar
  25. 25.
    Kissin EY, Merkel PA (2003) Diagnostic imaging in Takayasu arteritis. Curr Opin Rheumatol 16:31–37CrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2007

Authors and Affiliations

  • Samuel K. Shinjo
    • 1
  • Rosa M. R. Pereira
    • 1
  • Vivian A. P. Tizziani
    • 1
  • Ari S. Radu
    • 1
  • Maurício Levy-Neto
    • 1
  1. 1.Division of Rheumatology, School of MedicineUniversity of São PauloSão PauloBrazil

Personalised recommendations