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Mycophenolate mofetil as first-line treatment improves clinically evident early scleroderma lung disease
- Source :
- Rheumatology. 45:1005-1008
- Publication Year :
- 2006
- Publisher :
- Oxford University Press (OUP), 2006.
-
Abstract
- Objective. To find an effective, safe immunosuppressive regimen as an alternative to cyclophosphamide (Cy) for the treatment of clinically evident diffuse scleroderma (dSSc)-associated alveolitis of recent onset. Methods. Five consecutive patients with dSSc and recent-onset alveolitis were enrolled and treated with mycophenolate mofetil (MMF) and small (·10 mg/day) doses of predinisolone in this open-label trial. One patient with long-standing fibrosing alveolitis was later added to our cohort. Pulmonary function tests [carbon monoxide diffusing capacity (DLCO) and forced vital capacity (FVC)], pulmonary high-resolution computed tomography (HRCT) scans and clinical assessment were performed before and at specified time-points after enrolment. Cases of significant infections, leucopenia and abdominal pain were recorded. Results. After 4–6 months of MMF therapy, DLCO improved significantly compared with pre-treatment (mean DLCO 75.4% vs 64.2% of predicted value, respectively, P^0.033). Values of FVC also improved, with the difference almost reaching levels of statistical significance (mean FVC 76.2% vs 65.6% of predicted value, P^0.057). Ground glass opacities cleared in three of four patients with recent-onset alveolitis and were reduced in one patient after 6–8 months of treatment. Breathlessness and cough improved by 3 months. A possible treatment failure was seen in one patient. However, in five patients functional and clinical improvement was sustained during the study period. No adverse events were recorded in this ongoing clinical trial. Conclusion. Our preliminary data suggest that in patients with dSSc and recent, clinically apparent alveolitis, early treatment with MMF and small doses of corticosteroids (CS) may represent an effective, well-tolerated and safe alternative therapy.
- Subjects :
- Adult
Male
medicine.medical_specialty
Vital capacity
Adolescent
Prednisolone
Pulmonary Fibrosis
Vital Capacity
Gastroenterology
Scleroderma
Pulmonary function testing
FEV1/FVC ratio
Rheumatology
DLCO
Internal medicine
medicine
Humans
Pharmacology (medical)
Prospective Studies
Treatment Failure
Adverse effect
Prospective cohort study
Glucocorticoids
business.industry
Anti-Inflammatory Agents, Non-Steroidal
Respiratory disease
Middle Aged
Mycophenolic Acid
medicine.disease
Surgery
Scleroderma, Diffuse
Pulmonary Diffusing Capacity
Drug Therapy, Combination
Female
Tomography, X-Ray Computed
business
Subjects
Details
- ISSN :
- 14620332 and 14620324
- Volume :
- 45
- Database :
- OpenAIRE
- Journal :
- Rheumatology
- Accession number :
- edsair.doi.dedup.....65b1ea9dad20208fde1332ee1bc46cc2
- Full Text :
- https://doi.org/10.1093/rheumatology/kei211