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Mycophenolate for Immune-Mediated Hemolytic Anemia

Clinician's Brief (Capsule)

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Idiopathic immune-mediated hemolytic anemia (IMHA) is diagnosed when all other causes have been excluded; treatment entails suppressing the immune system. This retrospective study compared 2 treatments for idiopathic IMHA. One treatment regimen used glucocorticoids and mycophenolate mofetil (MMF; n = 30) whereas the other used alternate immunosuppressive protocols combining glucocorticoids with another secondary immunosuppressive agent: cyclosporine (n = 15), azathioprine (n = 6), or human immunoglobulin (n = 1).

Treatment of idiopathic IMHA with MMF and glucocorticoids was as safe and efficacious as combining glucocorticoids and another immunosuppressive drug. The MMF-treated group had no difference in short-term survival rates, length of hospitalization, or number of transfusions given.

MMF is available in oral and parenteral formulations, making it a convenient adjunctive therapy to glucocorticoids. At 10 mg/kg IV or PO q12h, MMF provided safe immunosuppression for the treatment of idiopathic IMHA. The MMF group had fewer adverse effects than the alternate groups. The authors recommended further trials to more accurately compare the effectiveness of MMF when used as a combination therapy for idiopathic IMHA.

Commentary

Many clinicians have become comfortable using protocols that include cyclosporine and/or azathioprine, but, because of its prohibitive expense, had not used MMF as a first-line agent before it was available in generic form. The research argued convincingly for considering MMF in conjunction with glucocorticoids for treating IMHA because of its oral and parenteral formulations, rapid onset of action, efficacy, affordability, and safety when compared with other commonly used immunosuppressive agents.—Dara Zerrenner, VMD, MS, DACVIM

Source

Treatment of canine idiopathic immune-mediated haemolytic anaemia with mycophenolate mofetil and glucocorticoids: 30 cases (2007 to 2011). Wang A, Smith JR, Creevy KE. J SMALL ANIM PRACT 54:399-404, 2013.

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