Mycophenolate mofetil; a review of indications and use in a large tertiary hospital

Mycophenolate Mofetil (MMF) has been registered for use in Australia since 1997 for prophylaxis of solid organ allograft rejection. MMF is now increasingly used for indications outside solid organ allograft rejection, often with limited supporting efficacy data. The purpose of this audit was to examine the patterns of use, reported side effects and cost impact of the drug in the Clinical and Immunology and Allergy (CIA) unit of Australia's largest teaching hospital. Prescription patterns for MMF by consultant immunologists at Westmead hospital between 2000 and 2004 were obtained from the pharmacy. These data were sorted for non-S100 indications. A single immunologist then reviewed the patient files. We also reviewed the literature on the use of this promising immunosuppressant. There has been a marked increase in use of MMF since year 2000 by the Department of CIA. A total of 75 patients were prescribed MMF for non-S100 indications. Common indications were systemic lupus erythematosus, pemphigus vulgaris, chronic idiopathic urticaria, myasthenia gravis, polymyositis, atopic dermatitis, Sjögren's disease, uveitis and vasculitis. It is clear that MMF has potential for use in a number of immunological disorders because of its relatively benign side effect profile and observed efficacy. Double blinded, placebo-controlled, multicentre trials are necessary to establish its therapeutic role. Our study highlights some of the conditions for which this agent is useful.