Mycophenolate mofetil appears to be effective second-line treatment for TED

Mycophenolate mofetil (MMF) appears safe and effective as a second-line immunosuppressive agent in patients with thyroid eye disease (TED), according to a study.

In this retrospective cohort study, 20 patients with active moderate-severe to sight-threatening TED were followed over 4 years (Weeks 24, 52 and 78) to evaluate the clinical efficacy of MMF dosing and side effects.

The median duration of treatment with MMF was 76 weeks, with 10% of patients stopping treatment prior to 24 weeks. More than half of patients (55%) had dysthyroid optic neuropathy (DON).

Clinical efficacy was seen in all patients (8/8) without DON at 24 weeks, 87.5% (7/8) at 52 weeks, and 83.3% (5/6) at 78 weeks. Clinical Activity Score (CAS) decreased from baseline from 2.78±1.99 to 0.50±0.58, 0.50±0.82 and, 1.00±1.30 at 78 weeks, respectively.

In patients with DON, improvements were seen in 90% (9/10) at 24 weeks, 100% (7/7) at 52 weeks and 100% (4/4) at 78 weeks. CAS scores were significantly reduced from 2.55±1.54 to 0.83±1.27, 1.00±1.17, and 0.63±0.95, respectively. Improvements in Gorman score, visual acuity, and soft tissue inflammation parameters were also noted.

Reference
Quah Qin Xian N, Alnahrawy A, Akshikar R, et al. Real-world efficacy and safety of mycophenolate mofetil in active moderate-to-sight-threatening thyroid eye disease. Clin Ophthalmol. 2021;15:1921-1932. doi: 10.2147/OPTH.S305717. PMID: 34007144; PMCID: PMC8121682.