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• W3209899298 abstract "Introduction: Mycophenolate mofetil (MMF) is a widely used drug with immunosuppressive properties. Gastrointestinal (GI) toxicity may result, which is incompletely described in existing literature. The primary aims of this study were to characterize MMF GI toxicity and determine risk factors for severe disease and poor prognosis. Methods: A retrospective chart review was performed at a single tertiary academic center. We sought potential cases of MMF toxicity by querying a pathology database with “mycophenolate”, “crypt epithelial apoptosis”, and “history of transplant”. All resulting charts were reviewed for demographic and clinical information at the time of biopsy including symptoms, vital signs, laboratory results, endoscopy reports, and outcomes. Lower endoscopies were scored using Mayo endoscopic subscore (MES). We defined severe disease as: severe abdominal pain, ≥7 bowel movements/day, heart rate ≥100 bpm, and/or acute kidney injury (AKI). We defined poor prognosis as time to improvement ≥1 week. Fisher's exact test was used to compare covariate distributions between exposure and outcome groups. Threshold for statistical significance was set at P ≤ 0.05. Results: Forty-four patients were analyzed. The majority were male (55%), white (52%), and not Hispanic or Latino (91%). Mean age was 56±14 years. Mean body mass index was 27.58±6.59 kg/m2. Most patients were nonsmokers (52%) or former smokers (41%). The most common indication for MMF was renal transplant (45%) with other common indications including non-liver non-renal transplant (25%) or liver transplant (23%). Median MMF dose was 1000 mg total daily. See Table for symptoms and signs upon presentation. Mean heart rate was 81±14 beats per minute and mean hemoglobin was 9.7±2.5 g/dL. Eleven patients underwent EGD only, 17 underwent colonoscopy or flexible sigmoidoscopy only, and 16 patients underwent both upper and lower endoscopies. MMF was discontinued in 57%, reduced in 20%, and unchanged in 23%. Sixty-one percent met criteria for severe disease and 81% met criteria for poor prognosis. Friability on endoscopy was associated with severe disease (P = 0.02); erosions/ulcerations trended towards significance (P = 0.09). Nausea and erythema on endoscopy were associated with poor prognosis (P = 0.05 and P < 0.01, respectively); MES trended towards significance (P = 0.07). Conclusion: In this cohort of patients with MMF GI toxicity, friability was associated with severe disease and nausea and erythema were associated with poor prognosis.Table 1.: Symptoms and signs upon presentation of patients with mycophenolate mofetil gastrointestinal toxicity." @default.
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• W3209899298 date "2021-10-01" @default.
• W3209899298 modified "2023-09-26" @default.
• W3209899298 title "S3308 Characterization of Mycophenolate Mofetil Gastrointestinal Toxicity and Risk Factors for Severe Disease and Poor Prognosis" @default.
• W3209899298 doi "https://doi.org/10.14309/01.ajg.0000786764.63177.77" @default.
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