Clinical Features and Outcomes of Mycophenolate Mofetil-induced Diarrhea: A Systematic Review
Prajwal Dhakal
Michigan State University, East Lansing, MI, USA
Rakesh K. Gami *
All Saints University, Kingstown, Saint Vincent and the Grenadines
Adams Kusi Appiah
University of Nebraska Medical Center, Omaha, NE, USA
Smith Giri
The Yale New Haven Hospital, New Haven, CT, USA
Harlan Sayles
University of Nebraska Medical Center, Omaha, NE, USA
Vijaya R. Bhatt
University of Nebraska Medical Center, Omaha, NE, USA
*Author to whom correspondence should be addressed.
Abstract
Mycophenolate Mofetil (MMF) is an immunosuppressive drug frequently used for prevention of graft rejection in solid-organ and hematopoietic stem cell transplants. MMF-induced diarrhea is a known complication, however, details regarding its clinical manifestations, treatment options, and outcomes are less clear. Differentiating MMF-induced diarrhea from other causes of diarrhea in an immunocompromised host on the basis of histology may be difficult, hence deeper clinical understanding of MMF-induced diarrhea can be valuable. Our objective was to determine the clinical manifestations and outcomes of MMF-induced diarrhea. Major databases were searched to include 44 articles that provided data on 560 episodes of diarrhea induced by MMF or its derivatives.
Results depicted the median age of 45 years (range 8-70); 29% were females. The latency between use of MMF and onset of diarrhea was 990 days (range 12- 5760). Watery diarrhea was the presenting symptom in 98%. MMF was discontinued or dose reduced in 56%, switched to enteric coated mycophenolate mofetil sodium in 12%, and continued in 14%. Eighty-five percent of cases who were managed with discontinuation/dose reduction of MMF and 81% of cases who switched from MMF to enteric coated mycophenolate mofetil sodium responded. The median time to response for either change to enteric coated mycophenolate sodium or discontinuation/dose reduction of MMF was 20 days (range 1-120 days).
Thus, MMF-induced diarrhea generally presents with watery diarrhea, and a majority of patients respond to discontinuation or dose reduction of MMF within a few weeks. Where continuation of MMF is important, a different drug formulation may be an option.
Keywords: Mycophenolate mofetil, mycophenolic acid, diarrhea, mycophenolate mofetil induced diarrhea.