Muscle & nerve · 2026
Serum Mycophenolic Acid Levels and Infection Risk in Myasthenia Gravis.
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Sohn Gyeong Mo, Shin Kyong Jin
Аннотация
INTRODUCTION/AIMS: Evidence linking serum mycophenolic acid (MPA) concentrations with safety outcomes in myasthenia gravis (MG) is limited. We evaluated whether single serum MPA concentrations were associated with clinically documented infection.
METHODS: This retrospective study included acetylcholine receptor antibody-positive MG patients treated with mycophenolate mofetil (MMF) for at least 1 year who had MPA and mycophenolic acid glucuronide (MPAG) measurement with same-day complete blood count testing. Exact sampling time relative to MMF dosing was not uniformly documented; therefore, values were analyzed as single serum concentrations rather than confirmed trough levels.
RESULTS: Among 112 MMF-treated patients, 60 had MPA/MPAG measurement, and 10 had recent infection. Serum MPA concentration correlated strongly and positively with MPAG concentration (r = 0.717) and moderately and inversely with lymphocyte count (r = -0.406). Infection occurred in 0/18 low, 2/24 intermediate, and 8/18 high MPA concentration groups. Patients with infection had higher MPA concentration (median 6.15 vs. 1.80 μg/mL; Bonferroni-adjusted p = 0.032) and higher MPA concentration per prescribed MMF dose.
DISCUSSION: Higher single serum MPA concentrations were associated with recent infection. Prospective controlled studies including patients not treated with MMF are needed.
METHODS: This retrospective study included acetylcholine receptor antibody-positive MG patients treated with mycophenolate mofetil (MMF) for at least 1 year who had MPA and mycophenolic acid glucuronide (MPAG) measurement with same-day complete blood count testing. Exact sampling time relative to MMF dosing was not uniformly documented; therefore, values were analyzed as single serum concentrations rather than confirmed trough levels.
RESULTS: Among 112 MMF-treated patients, 60 had MPA/MPAG measurement, and 10 had recent infection. Serum MPA concentration correlated strongly and positively with MPAG concentration (r = 0.717) and moderately and inversely with lymphocyte count (r = -0.406). Infection occurred in 0/18 low, 2/24 intermediate, and 8/18 high MPA concentration groups. Patients with infection had higher MPA concentration (median 6.15 vs. 1.80 μg/mL; Bonferroni-adjusted p = 0.032) and higher MPA concentration per prescribed MMF dose.
DISCUSSION: Higher single serum MPA concentrations were associated with recent infection. Prospective controlled studies including patients not treated with MMF are needed.