Blood Concentration Monitoring And Clinical Efficacyassessment Of Mycophenolate Mofetil In The Treatment Of Neuromyelitis Optica Spectrum Disorders

Objective:To evaluate the range of blood concentration and clinical efficacy of mycophenolate mofetil in the neuromyelitis optica spectrum disorders,and to explore whether the clinical effects is related to the blood concentration in patients with neuromyelitis optica spectrum disorders.Methods:The study recruited 22 neuromyelitis optica spectrum disorders(NMOSD)patients receiving mycophenolate mofetil with blood concentration monitoring from January 1,2015 to January 1,2019 admitted to the Department of Neurology,First Affiliated Hospital of Shanxi Medical University After oral administration of mycophenolate mofetil(MMF)to reach steady state,the trough blood concentration of mycophenolic acid(MPA)was measured(C0),and the correlation of the blood concentration of MPAC0 in NMOSD patients and the dose of MMF was analyzed.Evaluating the patients’ kurtzke expanded disability scale(EDSS)and annual recurrence rate(ARR)of before and after treatment.The ARR and EDSS scores were compared before and after treatment to evaluate the clinical efficacy.Assessing the correlation before and after treatment ARR difference and MPAC0。Results:Among 22 NMOSD patients taking MMF orally,77.3% of them had MPAC0 blood concentration of 1-3.5mg·L-1.the ARR value before treatment is 1.00(1.00,1.67)and the ARR value after treatment is 0.00(1.00,0.00).to compare ARR of before and after treatment,there was significant difference in ARR value(P<0.05);the EDSS value after treatment was 1.50(1.00,2.00),which was significantly lower than the EDSS score of2.00(1.00,4.00)before MMF treatment,and the EDSS score was significant difference(P<0.05).The correlation between MMF dose and MPAC0 was performed and MMF and MPAC0 Correlation analysis showed that the correlation coefficient between MMF and MPAC0 was 0.303,and the corresponding p value was 0.171,which was greater than 0.05 and no statistical significance.It can be considered that there was no correlation between MMF oral dose and blood drug concentration.Through the correlation analysis of ARR difference between before and after treatment and MPAC0 blood concentration,the results showed that the correlation coefficient between ARR difference between before and after treatment and MPAC0 was 0.5075,and the corresponding p value was 0.0159,less than 0.05,which was statistically significant.Conclusion:The blood concentration range of mycophenolate mofetil in patients with neuromyelitis optica spectrum disorders is basically consistent with the safe range of renal transplantation.This study shows that there is no correlation between the dose of mycophenolate mofetil and blood concentration.Within this blood concentration range,the treatment of optic neuromyelitis disease with mycophenolate mofetil significantly reduced the annual recurrence rate of patients,and maintained or improved EDSS scores with significant efficacy and good tolerance.There was a correlation between ARR improvement before and after treatment and MPAC0。MPAC0 may be better guide clinical medication.