mycophenolic-acid and Polyneuropathies

Multifocal motor neuropathy (MMN) is characterised by progressive, predominantly distal, asymmetrical limb weakness and usually multiple partial motor nerve conduction blocks. Intravenous immunoglobulin (IVIg) is beneficial but the role of immunosuppressive agents is uncertain. This is an update of a review first published in 2002 and previously updated in 2003, 2005, 2008 and 2011.. To assess the effects of immunosuppressive agents for the treatment of multifocal motor neuropathy.. On 22 September 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE and LILACS for trials of MMN. We also searched two trials registers for ongoing studies.. We planned to include randomised controlled trials (RCTs) and quasi-RCTs. We considered prospective and retrospective case series and case reports in the Discussion.. Two review authors searched the titles and abstracts of the articles identified and extracted the data independently.. Only one RCT of an immunosuppressive or immunomodulatory agent has been performed in MMN. This study randomised 28 participants and showed that mycophenolate mofetil, when used with IVIg, did not significantly improve strength, function or reduce the need for IVIg. No serious adverse events were observed. The study was deemed at low risk of bias. We summarised the results of retrospective and prospective case series in the discussion.. According to moderate quality evidence, mycophenolate mofetil did not produce significant benefit in terms of reducing need for IVIg or improving muscle strength in MMN. Trials of other immunosuppressants should be undertaken.

Topics: Drug Therapy, Combination; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Immunosuppressive Agents; Motor Neuron Disease; Muscle Strength; Mycophenolic Acid; Polyneuropathies; Randomized Controlled Trials as Topic

Multifocal motor neuropathy is characterised by progressive, predominantly distal, asymmetrical limb weakness and usually multiple partial motor nerve conduction blocks. Intravenous immunoglobulin is beneficial but the role of immunosuppressive agents is uncertain. This is an update of a review first published in 2002 and previously updated in 2003, 2005 and 2008.. To provide the best available evidence from randomised controlled trials on the role of immunosuppressive agents for the treatment of multifocal motor neuropathy.. We searched the Cochrane Neuromuscular Disease Group Specialized Register (4 October 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (2011, Issue 3 in The Cochrane Library), MEDLINE (January 1966 to September 2011), EMBASE (January 1980 to September 2011), and LILACS (January 1982 to September 2011) for trials of multifocal motor neuropathy.. We planned to include randomised and quasi-randomised controlled trials. We considered prospective and retrospective case series and case reports in the Discussion.. Two review authors searched the titles and abstracts of the articles identified and extracted the data independently.. Only one randomised controlled trial of an immunosuppressive or immunomodulatory agent has been performed in multifocal motor neuropathy. This study randomised 28 participants and showed that mycophenolate mofetil, when used with intravenous immunoglobulin, did not significantly improve strength, function or reduce the need for intravenous immunoglobulin. No serious adverse events were observed. The study was deemed at low risk of bias. We summarised the results of retrospective and prospective case series in the discussion.. According to moderate quality evidence, mycophenolate mofetil did not produce significant benefit in terms of reducing need for intravenous immunoglobulin or improving muscle strength. Trials of other immunosuppressants should be undertaken.

Topics: Drug Therapy, Combination; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Immunosuppressive Agents; Motor Neuron Disease; Mycophenolic Acid; Polyneuropathies; Randomized Controlled Trials as Topic

Multifocal motor neuropathy is characterised by progressive, predominantly distal, asymmetrical limb weakness and usually multiple partial motor nerve conduction blocks. Intravenous immunoglobulin is beneficial but the role of immunosuppressive agents is uncertain.. To provide the best available evidence from randomised controlled trials on the role of immunosuppressive agents for the treatment of multifocal motor neuropathy.. For this update, we searched the Cochrane Neuromuscular Disease Group Trials Register (October 8 2008), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 4), MEDLINE (from January 1966 to October 8 2008), and EMBASE (from January 1980 to October 8 2008), for trials of multifocal motor neuropathy.. Randomised and quasi-randomised controlled trials were to be included and one was found. Prospective and retrospective case series and case reports were considered in the Discussion.. Two review authors searched the titles and abstracts of the articles identified and extracted the data independently.. In this update, we found the first randomised controlled trial of multifocal motor neuropathy. This study, which randomised 28 patients, showed that mycophenolate mofetil did not significantly improve strength or function or reduce the need for intravenous immunoglobulin. We summarised the results of retrospective and prospective case series in the discussion.. In the only randomised placebo-controlled trial of any immunosuppressive agent, mycophenolate mofetil did not produce significant benefit. Trials of other immunosuppressants should be undertaken.

Topics: Humans; Immunosuppressive Agents; Motor Neuron Disease; Mycophenolic Acid; Polyneuropathies; Randomized Controlled Trials as Topic

We report favorable results of the long term use of mycophenolate in the treatment of three patients with myasthenia gravis (MG), two patients with chronic inflammatory demyelinating polyneuropathy (CIDP), one patient with secondary polymyositis (PM), and one patient with inclusion body myositis (IBM). Side effects were mild. Mycophenolate appears to be a useful addition to the armamentarium of immunosuppressants for treatment of chronic immunologically mediated neuromuscular diseases.

Topics: Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Chronic Disease; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Myasthenia Gravis; Mycophenolic Acid; Myositis, Inclusion Body; Polyneuropathies; Prednisone; Treatment Outcome

Chronic inflammatory axonal polyneuropathy (CIAP) is defined on the basis of the clinical, electrophysiological and nerve biopsy findings and therapeutic responses of 'immunotherapy responding chronic axonal polyneuropathy (IR-CAP)'.. The diagnosis of IR-CAP was made when all of three of the following mandatory criterion were met: (1) acquired, chronic progressive or relapsing symmetrical or asymmetrical polyneuropathy with duration of progression >2 months; (2) electrophysiological evidence of axonal neuropathy in at least two nerves without any evidence of 'strict criteria of demyelination'; and (3) definite responsiveness to immunotherapy.. Thirty-three patients with IR-CAP showed similar clinical features of chronic inflammatory demyelinating polyneuropathy (CIDP) except 'motor neuropathy subtype'. High spinal fluid protein was found in 27/32 (78%) cases. 'Inflammatory axonal neuropathy' was proven in 14 (45%) of 31 sural nerve biopsies.. IR-CAP could well be 'axonal CIDP' in view of clinical similarity, but not proven as yet. Thus, IR-CAP is best described as CIAP, a distinct entity that deserves its recognition in view of responsiveness to immunotherapy.. Diagnosis of CIAP can be made by additional documentation of 'inflammation' by high spinal fluid protein or nerve biopsy in addition to the first two diagnostic criteria of IR-CAP.

Topics: Adolescent; Adult; Aged; Autoimmune Diseases of the Nervous System; Axons; Azathioprine; Biopsy; Child; Child, Preschool; Chronic Disease; Cyclophosphamide; Cyclosporine; Electromyography; Female; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Inflammation; Male; Middle Aged; Mycophenolic Acid; Neural Conduction; Polyneuropathies; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating; Sural Nerve; Young Adult

To describe the clinical characteristics, histopathologic features, and outcomes of patients in whom vasculitis developed in association with use of tumor necrosis factor-α (TNF-α) inhibitors.. This is a retrospective review of patients evaluated at Mayo Clinic, Rochester, Minnesota, from January 1, 1998, through March 31, 2011, with a diagnosis of vasculitis induced by anti-TNF-α therapy.. Of 8 patients with vasculitis associated with anti-TNF-α therapy (mean age, 48.5 years), 6 (75%) were female. Four (50%) had rheumatoid arthritis, 1 (13%) had Crohn disease, and 3 (38%) had ulcerative colitis. Five (63%) were treated with infliximab, 2 (25%) with etanercept, and 1 (13%) with adalimumab. The mean duration of treatment before development of vasculitis was 34.5 months. The skin was the predominant organ affected (5 patients [63%]), with the most common cutaneous lesion being palpable purpura (4 of 5 [80%]). Two organs involved in systemic vasculitis were the peripheral nervous system (4 patients [50%]) and kidney (1 patient [13%]). All cases of vasculitis were histopathologically confirmed. Seven of 8 patients improved with discontinuation of therapy (mean time to resolution, 6.9 months) and adjuvant treatment (all 8 received prednisone; another agent was also used in 7); rechallenge with anti-TNF-α therapy was not attempted in any patient. At last follow-up, no patients had experienced a recurrence of vasculitis after therapy discontinuation.. Cutaneous small-vessel vasculitis was the most common finding, but systemic vasculitis, including peripheral nerve and renal vasculitis, was also frequently observed.

Topics: Adalimumab; Adult; Aged; Anti-Inflammatory Agents; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal, Murine-Derived; Arthritis, Rheumatoid; Azathioprine; Colitis, Ulcerative; Crohn Disease; Cyclophosphamide; Etanercept; Female; Glucocorticoids; Hematuria; Humans; Immunoglobulin G; Immunologic Factors; Infliximab; Male; Methotrexate; Middle Aged; Mycophenolic Acid; Polyneuropathies; Prednisone; Proteinuria; Receptors, Tumor Necrosis Factor; Retrospective Studies; Rituximab; Tumor Necrosis Factor-alpha; Vasculitis; Young Adult

Topics: Amyotrophic Lateral Sclerosis; Animals; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Carcinoma, Small Cell; Disease Models, Animal; Humans; Immunologic Factors; Immunosuppressive Agents; Lambert-Eaton Myasthenic Syndrome; Lung Neoplasms; Mycophenolic Acid; Myelin-Associated Glycoprotein; Neuromuscular Diseases; Polyneuropathies; Rats; Rituximab; Superoxide Dismutase; Superoxide Dismutase-1