Abstract：OBJECTIVE: To evaluate the clinical efficacy of mycophenolate mofetil (MMF) in the treatment of systemic-onset juvenile idiopathic arthritis (SoJIA). METHODS: Thirty-five patients with a confirmed diagnosis of SoJIA who had received initial treatment were randomly divided into control (n=15), MMF1 (n=7) and MMF2 groups (n=13). The control group received conventional treatment, the MMF1 group received MMF after 2 weeks of conventional treatment that had not led to remission, and the MMF2 group received combination therapy with non-steroidal anti-inflammatory drugs, prednisone and MMF. Symptoms, signs, laboratory indices, and adverse events were observed after 2, 4, and 12 weeks of treatment, and follow-up was performed for 3-6 months. RESULTS: Before treatment, the MMF2 group had a significantly longer disease course than the control group (P<0.05). After 2 weeks of treatment, the MMF1 and MMF2 groups had a significantly lower prednisone dose and erythrocyte sedimentation rate (ESR) than the control group (P<0.05). The MMF1 group had significantly higher body temperature than the other two groups (P<0.05). After 4 weeks of treatment, the MMF1 group had a significantly lower prednisone dose and ESR than the control group (P<0.05). The MMF2 group had a significantly lower prednisone dose, body temperature (recovery to normal), white blood cell count, ESR and serum ferritin concentration than the control group (P<0.05). Body temperature was significantly lower in the MMF2 group than in the MMF1 group (P<0.05). No adverse events were observed in either the MMF1 or MMF2 groups during treatment. CONCLUSONS: Combination therapy with MMF can lead to better control of the patient's condition, more rapid relief of clinical symptoms and reduced glucocorticoid dose. The therapy with MMF is safe in children.
HAN Tong-Xin,LI Cai-Feng,WANG Jiang et al. Clinical efficacy of mycophenolate mofetil in the treatment of systemic-onset juvenile idiopathic arthritis[J]. CJCP, 2013, 15(8): 666-670.
Lenz O, Fornoni A, Contreras G. Defining the role of mycophenolate mofetil in the treatment of proliferative lupus nephritis[J]. Drugs, 2005, 65(17): 2429-2436.
[5]
Provan D, Moss AJ, Newland AC, Bussel JB. Efficacy of mycophenolate mofetil as single-agent therapy for refractory immune thrombocytopenic purpura[J]. Am J Hematol, 2006, 81(1): 19-25.
[6]
Moudgil A, Bagga A, Jordan SC. Mycophenolate mofetil therapy in frequently relapsing steroid-dependent and steroid-resistant nephrotic syndrome of childhood: current status and future directions [J]. Pediatr Nephrol, 2005, 20(10): 1376-1381.
The Tricontinental Mycophenolate Mofetil Renal Transplantation Study Group. A blinded, randomized clinical trial of mycophenolate mofetil for the prevention of acute rejection in cadaveric renal transplantation [J]. Transplantation, 1996, 61: 1029-1037.
[9]
Ito S, Kamei K, Ogura M, Sato M, Fujimaru T, Ishikawa T, et al. Maintenance therapy with mycophenolate mofetil after rituximab in pediatric patients with steroid-dependent nephrotic syndrome [J]. Pediatr Nephrol, 2011, 26(10): 1823-1828.
[10]
Biester S, Deuter C, Michels H, Haefner R, Kuemmerle-Deschner J, Doycheva D, et al. Adalimumab in the therapy of uveitis in childhood [J]. Br J Ophthalmol, 2007, 91(3): 319-324.
[11]
Beukelman T, Ringold S, Davis TE, DeWitt EM, Pelajo CF, Weiss PF, et al. Disease-modifying antirheumatic drug use in the treatment of juvenile idiopathic arthritis: a cross-sectional analysis of the CARRA Registry[J]. J Rheumatol, 2012, 39(9): 1867-1874.
[12]
Farruggia P, Macaluso A, Tropia S, Genova S, Paolicchi O, Di Marco F, et al. Effectiveness of cyclosporine and mycophenolate mofetil in a child with refractory evans syndrome [J]. Pediatr Rep, 2011, 3(2): 49-50.
[13]
Ogimi C, Honma N, Tanaka R, Oh-ishi T. Mycophenolate mofetil therapy for juvenile dermatomyositis with immune thrombocytopenic purpura[J]. Mod Rheumatol, 2012, 22(2): 280-283.
[14]
Baratta A, Camarillo D, Papa C, Treat JR, Payne AS, Rozenber SS, et al. Pediatric pemphigus vulgaris: durable treatment responses achieved with prednisone and mycophenolate mofetil (MMF) [J]. Pediatr Dermatol, 2013, 30(2): 240-244.
[15]
Waxweiler WT, Agans R, Morrell DS. Systemic treatment of pediatric atopic dermatitis with azathioprine and mycophenolate mofetil [J]. Pediatr Dermatol, 2011, 28(6): 689-694.
