使用低劑量mycophenolate mofetil於結締組織疾病相關之間質性肺病之單一中心經驗

A single center experience of low-dose mycophenolate mofetil in connective tissue disease-related interstitial lung disease

目的：研結締組織相關之間質性肺病的標準治療為同時使用抑制發炎及纖維化之藥物。Mycophenolate mofetil (MMF)為標準治療之一，但高劑量MMF容易產生諸多副作用。此研究目的為了解在結締組織相關之間質性肺病使用低劑量MMF為標準治療是否仍能減緩肺功能變化。
方法：本回溯性研究選擇2016至2022年間在振興醫院有任一結締組織疾病，經放射科醫師認定為間質性肺病，且於診斷間質性肺病時開始使用MMF之病人。追蹤病人治療後一年的肺功能變化。
結果：本研究共收錄23位結締組織相關間質性肺病之病人，其中有7人MMF劑量為每日500毫克，其餘16人為每日1000毫克。治療一年後的平均用力呼氣肺活量(FVC)變化及標準差為0.11±0.36L，預估值變化及標準差為5.30±13.50%；平均一氧化碳擴散能力(DLco)的變化及標準差0.37±2.96 mL/mmHg/min，預估值變化及標準差為2.83±11.40%。肺功能在治療前後並無統計學上之差異。
結論：本研究結果為使用低劑量MMF時對一年後的肺功能變化並無顯著差異，意即在一年追蹤期可減緩肺功能的損失。但本研究有相當程度的研究限制，仍需更長的觀察期間以及更多的病人加入。

Objective: To compare the change of forced vital capacity (FVC) and Diffusing capacity of the lung for carbon monoxide (DLco) after 12-month treatment with low-dose mycophenolate mofetil (MMF).
Methods: The data of patients were collected retrospectively between 2016 and 2022 in Cheng Hsin General Hospital. Definite connective tissue disease-related interstitial lung disease was enrolled. The patients were required to take MMF as the initial management of ILD. Primary outcomes were absolute and predicted FVC/DLco change in a 12-month period.
Results: In our study, we enrolled a total of 23 patients. Among them, seven patients were administered a daily dose of 500mg of MMF, while the remaining patients received 1000mg/day of MMF. The changes observed in pulmonary function parameters were as follows: The absolute change in forced vital capacity (FVC) was 0.11±0.36 liters, and the change in %predicted FVC was 5.30±13.50%. Additionally, the absolute change in diffusing capacity of the lung for carbon monoxide (DLco) was 0.37±2.96 mL/mmHg/ min, and the change in %predicted DLco was 2.83±11.40%. Upon statistical analysis, the p-values for FVC, FVC%, DLco, and DLco% before and after treatment were 0.157, 0.552, 0.073, and 0.247, respectively. These results indicated that there was no statistically significant difference in pulmonary function changes observed in our study.
Conclusion: In summary, our observational study suggests that administering a lower dosage of MMF may help mitigate the decline in lung function over a 12-month period. However, to firmly establish the effectiveness of low-dose MMF, we recognize the need for a more extended observation period.