Enteric-coated mycophenolate sodium: a review of its use in the prevention of renal transplant rejection.

Enteric-coated mycophenolate sodium (Myfortic) is a reversible, noncompetitive inosine monophosphate dehydrogenase (IMPDH) inhibitor that is approved in the EU, the US and in other countries worldwide for immunosuppressive prophylaxis against graft rejection in adult renal transplant patients.Enteric-coated mycophenolate sodium has a delayed absorption from the gastrointestinal (GI) tract in comparison with mycophenolate mofetil, thereby potentially reducing GI adverse events. In randomized, double-blind trials of de novo and maintenance immunosuppressive therapy in renal transplant patients receiving ciclosporin emulsion-based regimens, enteric-coated mycophenolate sodium was as effective as mycophenolate mofetil in preventing renal graft rejection. Enteric-coated mycophenolate sodium provides an alternative to mycophenolate mofetil in the treatment of de novo renal transplant recipients and ongoing research should indicate whether an intensified dosage regimen can further improve clinical outcomes. Renal transplant patients receiving mycophenolate mofetil maintenance immunosuppressive therapy may be switched to enteric-coated mycophenolate sodium without compromising efficacy.The general tolerability profile of enteric-coated mycophenolate sodium was similar to that of mycophenolate mofetil. Patients selected for GI intolerance associated with mycophenolate mofetil treatment showed reductions in GI symptoms when switched to enteric-coated mycophenolate sodium, while in unselected patients in comparative trials, there was no difference between enteric-coated mycophenolate sodium and mycophenolate mofetil in GI tolerability. Enteric-coated mycophenolate sodium provides an alternative to mycophenolate mofetil in renal transplant patients receiving mycophenolate mofetil maintenance immunosuppressive therapy who have GI symptoms that have not responded to other management strategies, because they may experience improvement if switched to enteric-coated mycophenolate sodium. Thus, in association with ciclosporin-based regimens, enteric-coated mycophenolate sodium is a valuable treatment option for immunosuppressive prophylaxis in adult renal transplant recipients.