Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Mycophenolate Mofetil (MMF): Physician Prescribing Practices.
Malani1, Seema, Ginzler2, Ellen M.
To determine physician prescribing practices for mycophenolate mofetil (MMF, CellCept®) in North America
MMF is commercially available and used off-label for the treatment of SLE but consensus guidelines for its use in lupus and other autoimmune diseases are lacking. We were interested in learning the prescribing practices for MMF among rheumatologists and nephrologists, and their experience with efficacy and toxicity.
Approximately 700 adult and pediatric rheumatologists and nephrologists interested in SLE from the U.S. and Canada were invited via e-mail to complete an electronic survey, including 20 questions regarding their practice setting, ethnic composition of patients treated, dose and duration of MMF use, ethnic differences in response to MMF, and MMF use for extra-renal lupus and other autoimmune diseases.
141 physicians responded to the survey. The majority were rheumatologists (95.5%) with 3.5% nephrologists; 55% practice in an academic institution. The majority (60%) treat 1050 SLE patients/month. African-American/Afro-Caribbeans and Caucasians were the predominant population.
57% of respondents prescribe steroids with MMF as first line therapy for active lupus nephritis, predominantly for class III and IV nephritis; 36% favor steroids plus IV cyclophosphamide (IVC). 38% of respondents continue to prescribe MMF for treatment of severe active nephritis with worsening renal function. 85% of academic vs. 71% of private physicians prescribe MMF for both induction and maintenance in lupus nephritis (p=0.04). For patients who relapse on maintenance MMF, a similar number of respondents prescribe IVC for reinduction followed by maintenance MMF vs. azathioprine maintenance. Most respondents (75%) attempt a target MMF dose of 3 grams/day. 52% prefer to continue MMF indefinitely while 41% taper and discontinue the dose after achieving remission.
53% of respondents found no racial difference in response to MMF, while 23% did not have a heterogeneous racial population. Few commented on a need for a higher MMF dose in African-American patients.
MMF use for extra-renal lupus manifestations was reported for pulmonary disease (65%), hematologic (57%), cutaneous (48%), neuropsychiatric (44%), and arthritis (41%). MMF use in other autoimmune disease included systemic vasculitis (56%), inflammatory myopathies (50%), interstitial lung disease (44%), systemic sclerosis (33%).
Most respondents change from MMF to other maintenance drugs only for side effects or insurance coverage issues. GI side effects were the most common adverse events reported (84%), followed by infection (30%), and hematologic events (27%).
Despite a lack of guidelines for MMF use, it is the first choice therapy both in remission induction and maintenance of lupus nephritis. Most physicians continue MMF for a long duration. There also appears to be considerable use of MMF for treatment of extra-renal manifestations of SLE.
To cite this abstract, please use the following information:
Malani, Seema, Ginzler, Ellen M.; Mycophenolate Mofetil (MMF): Physician Prescribing Practices. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1866