Chest
Volume 133, Issue 2, February 2008, Pages 455-460
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Original Research
Interstitial Lung Disease
Effect of Mycophenolate Mofetil on Pulmonary Function in Scleroderma-Associated Interstitial Lung Disease

https://doi.org/10.1378/chest.06-2861Get rights and content

Objective

We sought to determine the effectiveness of mycophenolate mofetil (MMF) in scleroderma- associated interstitial lung disease (SSc-ILD).

Methods

We retrospectively identified patients who met criteria for systemic sclerosis, had evidence of SSc-ILD on chest CT, received > 1 g/d of MMF for ≥ 6 months, and had pulmonary function data available. Vital capacity (VC) and diffusion capacity of the lung for carbon monoxide (Dlco) at treatment onset were compared with VC and Dlco values 12 months before and 12 months after treatment onset. Twelve-month values were imputed from regression lines generated using all VC and Dlco measurements made in the 24-month period either prior to or following treatment onset.

Results

Among 13 patients who met inclusion criteria, MMF was associated with a significant improvement in VC (mean, + 159 mL; confidence interval [CI], + 30 to + 289 mL; and + 4% of the predicted normal value; CI, + 2 to + 7%) after 12 months of treatment. In contrast, patients had a significant decrease in VC (mean, – 239 mL; CI, – 477 to – 0.5 mL; and − 5% of the predicted normal value; CI, – 11 to − 0.3%) in the 12 months prior to MMF treatment. Dlco did not change significantly during MMF treatment (mean, + 1% of the predicted normal value; CI, – 2 to + 5%) but decreased significantly in the 12 months prior to treatment (mean, – 5% of the predicted normal value; CI, − 10 to − 1%).

Conclusion

These retrospective data suggest MMF improves VC in patients with SSc-ILD.

Section snippets

Materials and Methods

After approval by the Institutional Review Board and waiver of informed consent, patients were retrospectively identified who met American College of Rheumatology criteria for systemic sclerosis and were treated with MMF. Patients included in the study had a diagnosis of SSc-ILD (defined as abnormal high-resolution CT [HRCT] of the chest consistent with SSc-ILD and no other cause for interstitial lung disease apparent), received > 1 g/d of MMF for at least 6 months, and had measurements of VC

Case Identification

Twenty-three patients met criteria for systemic sclerosis and were treated with MMF. Ten of the 23 patients who received MMF did not meet criteria for inclusion because interstitial lung disease was not present (1 patient), pulmonary function tests were not available (1 patient), or MMF was not used for > 6 months (8 patients). Of those who used MMF for < 6 months, one patient stopped treatment due to nausea, one patient died of an unknown cause, two patients stopped treatment due to personal

Discussion

These data suggest that MMF improves VC in patients with SSc-ILD. MMF was associated with a statistically significant improvement in VC, reversing a significant decline in VC prior to starting MMF. In contrast, Dlco did not change significantly during MMF treatment.

The magnitude of the increase in VC was small and of questionable clinical significance. Although VC improved in 11 of 13 patients during MMF treatment, only 1 or 2 of those patients (depending on the method of analysis) achieved an

ACKNOWLEDGMENT

The authors wish to thank Amanda Mondt for assistance with data abstraction and Shannon Greer for assistance with manuscript preparation.

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  • Cited by (0)

    The authors have no conflicts of interest to disclose.

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