From the Guidelines
Mycophenolic acid (MPA) should be dosed at approximately 540–720 mg twice daily for the treatment of Myasthenia Gravis. When considering the treatment of Myasthenia Gravis with Mycophenolate, it's essential to prioritize the dosing of Mycophenolic acid (MPA) to minimize potential side effects while maximizing efficacy. According to the most recent and highest quality study available, 1, the recommended dose of MPA is approximately 540–720 mg twice daily. Key points to consider when prescribing MPA include:
- Starting with a lower dose and gradually increasing to the target dose to minimize gastrointestinal side effects
- Monitoring complete blood count and liver function tests regularly, typically monthly for the first 3 months, then every 3 months thereafter
- Being aware of common side effects, including gastrointestinal disturbances, increased risk of infections, and potential bone marrow suppression
- Understanding that clinical improvement may take 3-6 months to become apparent, so patience is necessary when initiating therapy
- Recognizing that MPA works by inhibiting lymphocyte proliferation, thereby reducing the autoimmune attack on acetylcholine receptors at the neuromuscular junction, and is often used as a steroid-sparing agent in Myasthenia Gravis.
From the Research
Dosing for Mycophenolate in Myasthenia Gravis
- The dosing for Mycophenolate (Mycophenolic acid) in the treatment of Myasthenia Gravis is typically in the range of 1.0-2.0 g/day 2 or ≥2 g per day for at least 8 months 3.
- A study found that mycophenolate mofetil in a dose of 1.0-2.0 g/day was effective in treating severe refractory myasthenia gravis with considerable improvement of myasthenic symptoms seen in all patients within 3-6 months after the initiation of this therapy 2.
- Another study compared the effectiveness of azathioprine and mycophenolate mofetil, with mycophenolate mofetil being administered at a dose of ≥2 g per day for at least 8 months 3.
Administration and Monitoring
- Mycophenolate mofetil is usually well tolerated and its application is simple 2.
- The choice of medication, dose, follow-up intervals, and drug monitoring should be determined by the treating clinicians 3.
- Outcome measures and adverse events should be recorded at each visit 3.
Efficacy and Safety
- Mycophenolate mofetil has shown promising effects in MG patients in preliminary studies 4.
- A study found that more than half of patients treated with mycophenolate mofetil felt their quality of life improved, with no difference in clinical outcomes noted between mycophenolate mofetil and azathioprine 3.
- Adverse events associated with mycophenolate mofetil were potentially less serious than those with azathioprine, although mycophenolate mofetil is teratogenic 3.