The role of mycophenolate mofetil in the therapy of thyroid eye disease

Thyroid eye disease (TED) is an autoimmune disorder that can threaten vision loss. In 90% cases, it is related to Graves' disease, and in 10% cases, it occurs with euthyroidism or with chronic autoimmune thyroiditis. It is the leading cause of orbital pathology in adults. The TED treatment remains challenging for clinicians, particularly in moderate-to-severe or sight-threatening forms of the disease. One-third of TED patients experience a relapse despite the corticosteroids as a first-line treatment. Some patients show poor response or even no response to the treatment. There are many adverse effects associated with chronic use of intravenous methylprednisolone (IVMP). There is a need for new, efficient therapeutic methods, such as immunomodulating drugs like mycophenolate mofetil (MMF). This paper describes the role and potential efficiency of MMF application in TED by its direct action on TED pathogenic mechanisms. The introduction of MMF in the second-line treatment helps decrease the level of clinical symptoms and the risk of chronic complications, while causing only a small number of adverse events. Nevertheless, it should be noted that there are no unified guidelines available for consolidating treatment focused on maintaining remission after the first dose of IVMP. Moreover, clinical knowledge on the use of MMF application in TED is still limited, and further research is needed. Nonetheless, the available evidence is promising and MMF may play a vital role in future therapeutic strategies.