mycophenolic-acid and Guillain-Barre-Syndrome

Topics: Adult; Aged; Anti-Inflammatory Agents; Drug Therapy, Combination; Female; Guillain-Barre Syndrome; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Male; Methylprednisolone; Middle Aged; Mycophenolic Acid; Pilot Projects

The emergence of immune checkpoint inhibitors (ICIs) has significantly prolonged the survival time of cancer patients. However, it may also lead to various immune-related adverse events (irAEs), including Guillain-Barré syndrome (GBS), a rare type of irAE. Most GBS patients can recover spontaneously due to the self-limited nature of the disease, but severe cases can result in respiratory failure or even death. Here we report a rare case of GBS occurring in a 58-year-old male patient with non-small cell lung cancer (NSCLC) who developed muscle weakness and numbness of the extremities during chemotherapy combined with KN046, a PD-L1/CTLA-4 bispecific antibody. Despite receiving methylprednisolone and γ-globulin, the patient's symptoms did not improve. However, there was significant improvement after treatment with mycophenolate mofetil (MM) capsules, which is not a routine regimen for GBS. To the best of our knowledge, this is the first reported case of ICIs-induced GBS that responded well to mycophenolate mofetil instead of methylprednisolone or γ-globulin. Thus, it provides a new treatment option for patients with ICIs-induced GBS.

Topics: Antibodies, Bispecific; Carcinoma, Non-Small-Cell Lung; Guillain-Barre Syndrome; Humans; Lung Neoplasms; Male; Methylprednisolone; Middle Aged; Mycophenolic Acid

This report concerns a case of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) with frequent treatment-dependent relapses. A 75-year-old male presented with a 2-month history of progressive weakness of the limbs with no sensory symptoms. Neurological examination revealed normal cranial nerves, MRC grade 4 power in the proximal and distal muscles of the limbs, and generalized areflexia. However, the sensory examination results, serum immunoelectrophoresis, anti-HIV antibody, and vitamins B1 and B12 levels were normal. Cervical MR imaging was unremarkable. Cerebrospinal fluid showed albuminocytologic dissociation. Nerve conduction studies demonstrated prolonged distal latencies in the bilateral median nerves and left ulnar nerve. Treatment with intravenous immunoglobulin (IVIg) infusion resulted in a marked improvement. Thereafter, the patient had been treated with repeated IVIg to maintain motor function. Subsequently, the patient fulfilled the EFNS/PNS diagnostic criteria for pure motor form of definite CIDP. Treatment with ciclosporin with the plasma trough level of 60-150 ng/ml reduced the frequency of IVIg. However, renal function began to deteriorate 94 months after the initiation of ciclosporin. The calcineurin inhibitor was replaced with mycophenolate mofetil 1,500 mg, which significantly increased the interval between infusions without further renal impairment. Therefore, mycophenolate may represent an effective alternative treatment for some IVIg-dependent CIDP patients.

Topics: Aged; Chronic Disease; Cyclosporine; Drug Therapy, Combination; Guillain-Barre Syndrome; Humans; Immunoglobulins, Intravenous; Kidney Diseases; Male; Mycophenolic Acid; Recurrence; Secondary Prevention; Time Factors; Treatment Outcome

To evaluate the efficacy of mycophenolate mofetil (MMF) in chronic inflammatory demyelinating polyneuropathy (CIDP).. Evidence is growing that MMF is effective as an immunomodulatory drug in neuromuscular diseases.. A database of 184 patients with CIDP was analysed to obtain clinical, laboratory and electrophysiological information for patients with CIDP treated with MMF.. Eight patients, who met the inclusion criteria, received MMF (mean dose 2 g/day; median duration 15.2 months). The average Neuropathy Impairment Score of the eight patients improved from baseline (72.3+/-35) after initiation of MMF therapy (37.8+/-37; p<0.001). Six of these eight patients were either able to stop concomitant medications (corticosteroid, intravenous immunoglobulin) or reduce their doses and frequency by > or = 50%.. Our pilot data suggest that MMF appears to be an effective therapy for patients with naive or refractory CIDP, and further controlled studies are warranted for their confirmation.

Topics: Adult; Anticarcinogenic Agents; Chronic Disease; Female; Guillain-Barre Syndrome; Humans; Male; Middle Aged; Mycophenolic Acid; Pilot Projects