Mycophenolate mofetil - Suggested guidelines for use in kidney transplantation

Mycophenolate mofetil (MMF) is an immunosuppressive drug designed to inhibi t inosine monophosphate dehydrogenase (IMPDH). IMPDH is a key enzyme in the de novo purine synthesis of lymphocytes, It is crucially important for pro liferative responses of human T and B lymphocytes, The inhibition of IMPDH thus leads to selective lymphocyte suppression. After successful use in var ious in vitro and animal models, MMF was brought to clinical trial in patie nts undergoing transplantation. The drug is rapidly and completely absorbed following oral administration. Pilot studies of administration with cyclos porin and corticosteroids suggested a significant reduction in the incidenc e of organ rejection at dosages of 1 to 3 g/day, As a result of these studi es, 3 pivotal randomised double-blind multicentre trials, involving nearly 1500 patients, were designed to investigate the effects of addition of MMF to different standard immunosuppressive protocols on the prevention of acut e renal allograft rejection. After 6 months, the rates of biopsy-proven rej ection were significantly reduced in patients receiving MMF. In combination with cyclosporin and corticosteroids, the adverse effect profile resembled that of azathioprine. Most adverse effects were associated with the gastro intestinal tract, the blood system and opportunistic infections. MMF offers improved immunosuppressive therapy following renal and probably other soli d organ transplantation. MMF has born licensed since 1995 for the preventio n of acute renal allograft rejection in most countries. It has been used in different combinations of immunosuppressive drugs and in various dosages a nd regimens.