Effect and safety of low dose of mycophenolate mofetil and n-acetyl cysteine in interstitial lung disease (ILD)

Background: In Interstitial lung disease (ILD), Glucocorticoids and immune-modulatory agents are mainstays of therapy. Only few studies with dose of 2-3 gm. /day have been performed for evaluation of role of Mycophenolate mofetil and N-acetyl-cysteine in ILD(IPF). Aims & objectives: In this study our objective were to examine the safety and efficacy of low dose Mycophenolate Mofetil (MMF) and N-Acetyl cysteine and to determine its impact on lung function in patients with ILD(IPF) based on the ILD subtypes. Methods: We retrospectively identified patients, who met the ATS/ERS 2010 criteria for ILD and received low dose of MMF 360 mg/ twice a day and N-Acetyl cysteine 600 mg tdsfor 12 months. All of them had routine laboratory, pulmonary function and radiological investigation (high resolution computed tomography-HRCT) data available and were enrolled in the study. Forced vital capacity (FVC), total lung capacity (TLC), diffusion capacity of the lung for carbon monoxide (DLCO), 6-minute walking distance (6MWD), HRCT scans and routine laboratory data at treatment onset were compared with respective values 6 and 12 months after treatment onset. Result:thirty two were treated with low dose MMF and N-Acetyl-cysteine for ILD (IPF). The most commonreason for initiating low dose MMF& N-Acetyl cysteine was an adverse effect of high dose of MMF and adverse effect of prior immunomodulatory agent. There were significant alterations in FVC, TLC, DLco and 6MWD pre and 6 and 12 months post treatment. No case of clinically significant infection leucopenia or elevated liver enzyme were recorded. Low dose MMF and N-acetyl-cysteine, well tolerated and allows reduction or discontinuation of steroids without worsening of symptoms or objective progressive of disease. MMF in combination with N-Acetyl cysteine is less toxic and its targeted anti fibrotic properties make it potentially more effective than other immunosuppressive. Conclusion; Low dose MMF 360 mg and N-Acetyl-cysteine 600 mg appears to be safe and well tolerated and show significant alterations in FVC, TLC, and DLCo in patients with ILD (IPF) and allows reduction or discontinuation of steroids without worsening of symptoms. Larger-scale studies are needed to further evaluate the efficacy of low dose of MMF and N-Acetyl cysteine in this patient population

Ankit Bhardwaj, Anand k. Shukla, Sunita Singh, Saborni and VIVEK Singh
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Int J Inf Res Rev
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