Study shows the efficacy and safety of mycophenolate mofetil glucocorticoid combination in treating IgG4-RD

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Immunoglobulin G4-related disease (IgG4-RD) is often underdiagnosed and there is no randomized trial evaluating the treatment modality as a whole for the disease or its subsets. Now, a recent study published in Clinical Rheumatology has concluded that combining glucocorticoids (GCs) with a lower dose of mycophenolate mofetil (MMF) is superior to GC plus leflunomide (LEF).

The retrospective cohort study analyzed the clinical data at baseline and after treatment in 130 IgG4-RD patients divided into groups receiving GCs + LEF and GCs + MMF. The researchers have noted a 100% treatment response in both the study groups during the 1st-month follow-up. After the 6th and 12th-month follow-up, a reduced response was found in the GCs + LEF group (53.7%) when compared to the GCs + MMF (75.6%) group. Rash and elevated liver enzymes were the adverse events reported among most of the patients in the LEF group.

A 2020 retrospective cohort study by Luo et al. found a significant reduction in relapse rate among IgG4-RD patients who received GCs + cyclophosphamide (CYC) than those with GCs + MMF. The relapsed patients achieved remission after shifting to either higher GC dose therapy or immunosuppressants. The GCs with CYC or MMF showed similar effects on IgG4-RD patients with organ involvement.

The present study is touted as the first of its kind to compare the efficacy and safety of GCs plus LEF/MMF against IgG4-RD. The findings widen the therapeutic options for the management of IgG4-RD.

References

  1. Chen Y, Li R, Luo X, Wu T, Li J, Liu Z, Peng Y, Lu H, Peng L, Zhou Y, Zeng X, Fei Y, Zhang W. Comparison of the efficacy and safety of leflunomide versus mycophenolate mofetil in treating IgG4-related disease: a retrospective cohort study. Clinical Rheumatology. 2023.
  2. Luo X, Peng Y, Zhang P, Li J, Liu Z, Lu H, Zhang X, Zeng X, Zhang F, Fei Y, Zhang W. Comparison of the effects of cyclophosphamide and mycophenolate mofetil treatment against immunoglobulin G4-related disease: a retrospective cohort study. Frontiers in Medicine. 2020 Jul 7;7:253.