Combination therapy with mycophenolate mofetil and ursodeoxycholic acid for primary biliary cirrhosis

Evidence of autoimmunity in primary biliary cirrhosis (PBC) provides a rati onale for treatment with an immunosuppressant. Such a drug should be suffic iently free from serious toxicities to enable patients with asymptomatic, b ut progressive, disease to be treated longterm. Mycophenolate mofetil (MMF) mediates immunosuppression by selectively and reversibly inhibiting lympho cyte function, and has a more acceptable safety profile than other immunosu ppressants that have been used in the treatment of this disease. Two patien ts, whose response to long-term treatment with ursodeoxycholic acid (UDCA) had been inadequate, were treated with a combination of MMF 2 g daily and U DCA 1 g daily for 12 months. In both patients this regimen was associated w ith no clinically significant adverse events, a decrease in elevated serum alkaline phosphatase levels to values close to the upper limit of normal, a nd an almost complete disappearance of the chronic inflammatory cell infilt rate that had been present in pre-combination treatment liver biopsies. MMF may be an appropriate immunosuppressive drug for use in the long-term trea tment of patients with PBC, including asymptomatic patients. Eur J Gastroen terol Hepatol 11:1165-1169 (C) 1999 Lippincott Williams & Wilkins.