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Systemic safety analysis of mycophenolate in Graves’ orbitopathy

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Abstract

Purpose

The dual antiproliferative mechanism of mycophenolate appears to be beneficial in Graves’ orbitopathy (GO).

Methods

Safety data from the two published mycophenolate trials and the original database of the European Group on Graves’ Orbitopathy (EUGOGO) trial were systematically analyzed. Treatment efficacy stratified by individual visual parameters of activity and severity were compared.

Results

A total of 129 adverse events (AE) involving 50 patients (29.4%) were noted among all mycophenolate-treated patients. Mycophenolate sodium plus intravenous glucocorticoid (MPS + GC) group of the EUGOGO trial recorded significantly more AE (55.4% versus 4.6% of patients affected) and serious adverse events (SAE) (12.5% versus 0%) than mycophenolate mofetil (MMF) group of the Chinese trial. None of those SAE was side effect (SE). Most SE in MPS + GC group were mild. Gastrointestinal disorders, infection and liver dysfunction affected 8.8%, 7.1% and 1.2% of all mycophenolate-treated patients (versus 5.4%, 5.4% and 1.2% of all patients on GC monotherapy, respectively). MPS + GC did not significantly increase the risk of infection or liver dysfunction when compared to GC monotherapy. No cytopenia, serious infection or treatment-related mortality was reported. The much higher AE rates of mycophenolate trials in other autoimmune diseases or transplantations suggested that major mycophenolate toxicities were mostly dose- and duration dependent. Mycophenolate, either as monotherapy or as combination, achieved better overall response than GC monotherapy.

Conclusion

The risk–benefit ratio of low-dose mycophenolate treatment in active moderate-to-severe GO is highly favorable given its reassuring safety profile with low rate of mild-to-moderate SE and promising efficacy.

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Authors and Affiliations

  1. Department of Medicine I, Johannes-Gutenberg University Medical Center, Langenbeckstreet 1, 55131, Mainz, Germany

    A. C. H. Lee, M. Riedl, L. Frommer, T. Diana & G. J. Kahaly

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  1. A. C. H. Lee
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  2. M. Riedl
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  3. L. Frommer
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  4. T. Diana
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  5. G. J. Kahaly
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Contributions

Literature search and data interpretation were performed by Riedl and Lee. The manuscript was written by Lee, Riedl and Kahaly. Kahaly, Diana and Frommer critically reviewed the manuscript.

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Correspondence to G. J. Kahaly.

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Lee, A.C.H., Riedl, M., Frommer, L. et al. Systemic safety analysis of mycophenolate in Graves’ orbitopathy. J Endocrinol Invest 43, 767–777 (2020). https://doi.org/10.1007/s40618-019-01161-z

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  • DOI: https://doi.org/10.1007/s40618-019-01161-z

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