Mycophenolic acid agents: is enteric coating the answer?

Wana Manitpisitkul¹, Sabrina Lee², Matthew Cooper^3
1Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA; ²Solid Organ Transplant Program, University of Utah Health Care, Salt Lake City, UT, USA; ³Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA

Abstract: Addition of mycophenolate mofetil (MMF) to calcineurin-based immunosuppressive therapy has led to a significant improvement in graft survival and reduction of acute rejection in renal transplant recipients. However, in clinical practice, MMF dose reduction, interruption, or discontinuation due to hematological and gastrointestinal (GI) side-effects occurred in up to 50% of the patients. Large retrospective analyses have demonstrated that patients requiring MMF dose manipulation due to adverse events experienced a higher rate of rejection and graft loss. Enteric-coated mycophenolate sodium (EC-MPS) was developed with the goal of improving upper GI side-effects. Here, we review the efficacy and safety of EC-MPS in de novo kidney transplant recipient, and in stable renal transplant patients who were converted from MMF. The changes in GI-related adverse events using patient-reported outcome instruments are also reviewed.

Keywords: enteric-coated mycophenolate sodium, mycophenolate mofetil, kidney transplant, efficacy, gastrointestinal tolerability