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Comparison of mid-term clinical outcome in heart transplantation patients using mycophenolate mofetil vs.
Kina Jeon1, Darae Kim1, Jin-Oh Choi1
1Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Background:
Mycophenolate mofetil (MMF) is a prodrug of mycophenolic acid (MPA) and a key immunosuppressant for improving graft survival in patients with heart transplantation (HTx). However, dose reduction or interruption is occasionally needed due to gastrointestinal (GI) side effects. Enteric-coated mycophenolate sodium (EC-MPS) is an alternative form of MPA delivery to improve GI tolerability. In the present study, the efficacy of EC-MPS compared with MMF in HTx patients was investigated.
Methods:
In this retrospective study, the Korean Organ Transplant Registry (KOTRY) data were used to analyze the efficacy and rejection rate of MMF and EC-MPS. A total of 611 patients was enrolled from 2014 to February of 2021. Patients were divided based on the use of MMF or EC-MPS at 6 months post-HTx. Patients who were not prescribed MMF or EC-MPS were excluded. Graft survival, all-cause mortality, and treated rejection were compared between the two groups. All statistical analyses were performed using SPSS; characteristics were compared using Pearson chi-square test and survival rate with Kaplan-Meier plot and log-rank test.
Results:
A total of 510 HTx patients was analyzed (mean age: 51.74 ± 13.16 years, males: 68.2%). At 6 months after HTx, 78 patients were taking EC-MPA (12.8%) and 432 patients were taking MMF (70.7%). The median follow-up was 42.0 months (IQR: 21.7-61.0 months). Post-HTx outcomes including overall survival, all cause mortality, acute cell mediated rejection (ACR), acute antibody mediated rejection (AMR), treated rejection, and cardiac allograft vasculopathy (CAV) were comparable between the two groups during follow-up.
Conclusion:
Notable differences were not observed in overall survival, all cause mortality, ACR, AMR, treated rejection, and CAV between MMF and EC-MPS groups. Efficacy of EC-MPS was similar to that of MMF in HTx patients during mid-term follow up after HTx.
Insights
Enteric-coated mycophenolate sodium (EC-MPS) shows similar efficacy to mycophenolate mofetil (MMF) in heart transplant recipients. This study found comparable graft survival and mortality rates between the two immunosuppressants, suggesting EC-MPS is a viable alternative for heart transplant patients.
Area of Science:
- Immunology
- Pharmacology
- Transplantation Medicine
Background:
- Mycophenolate mofetil (MMF) is a crucial immunosuppressant for heart transplant (HTx) patients.
- Gastrointestinal (GI) side effects of MMF can necessitate dose adjustments.
- Enteric-coated mycophenolate sodium (EC-MPS) offers an alternative MPA delivery to improve GI tolerability.
Purpose of the Study:
- To compare the efficacy of EC-MPS versus MMF in heart transplant recipients.
- To evaluate graft survival, mortality, and rejection rates between the two formulations.
Main Methods:
- Retrospective analysis of Korean Organ Transplant Registry (KOTRY) data from 2014 to 2021.
- Inclusion of 510 heart transplant patients, categorized by MMF or EC-MPS use at 6 months post-transplant.
- Comparison of outcomes including survival, mortality, acute rejection (ACR, AMR), and cardiac allograft vasculopathy (CAV) using statistical analyses.
Main Results:
- A total of 510 patients were analyzed; 78 received EC-MPA and 432 received MMF.
- Median follow-up was 42.0 months.
- No significant differences were observed in overall survival, all-cause mortality, ACR, AMR, treated rejection, or CAV between EC-MPS and MMF groups.
Conclusions:
- EC-MPS demonstrates comparable efficacy to MMF in heart transplant patients.
- Mid-term follow-up shows similar post-transplant outcomes between the two immunosuppressive agents.
- EC-MPS is a viable alternative to MMF for maintaining immunosuppression in heart transplant recipients.
