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Tuesday, January 27, 2015
What can you tell me about the effectiveness of Cellcept in treating MG?
This year two studies came out in the literature that drew serious doubts for mycophenolate (Cellcept) as a first line agent for myasthenia. Cellcept was used in conjunction with prednisone and neither study showed any benefit for controlling myasthenia over prednisone alone. You will find many neurologists who do not use the drug now at all in myasthenia. But the debate still continues about this drug. One study was only 12 weeks; was this too short a time period to really determine if the drug was effective? Patients with severe myasthenia were excluded. Did we study enough patients? Anecdotally, I would say I have used it on several patients in the past, and had success in just a few of those treated. The drug seems to be much better tolerated than some of the other immunosuppressants and is also touted as having a lower risk of long-term hematologic malignancies. I still use it, but not as a first or second line agent. I have attached the two citations for your interest.
- An international, phase III, randomized trial of mycophenolate mofetil in myasthenia gravis. Sanders DB et al. Neurology. 2008 Aug 5;71(6):400-6.
- A trial of mycophenolate mofetil with prednisone as initial immunotherapy in myasthenia gravis. The Muscle Study Group. Neurology. 2008 Aug 5;71(6):394-9.
Robert W Neel, IV, MD
Assistant Professor of Neurology
College of Medicine
University of Cincinnati