LAUSR

Background: Mycophenolate mofetil (MMF) has been increasingly used in various rheumatic diseases. It may also be a safe and effective treatment option for Behçet’s syndrome (BS) where oral immunosuppressives other than azathioprine and cyclosporine are not available. Objectives: We aimed to report our experience with MMF in BS patients with major organ involvement. Methods: We retrospectively reviewed the charts of all BS patients who started using MMF between 2016 and 2018. Demographic characteristics, MMF indication, history of previous immunosuppressive agents, concomitant therapies with MMF, adverse events and outcome were recorded from the chart review. Results: We evaluated 39 BS patients (M/W: 30/9, mean age: 39 ± 8 years) treated with MMF during a mean follow-up of 18 ± 13 months. Of 39 patients, 31 received MMF for maintenance of remission therapy, while 8 had active disease at the initiation of MMF. The main indications were vascular involvement in 26, eye involvement in 11, and neurologic involvement in 2 patients. Among the 26 patients with vascular involvement, 13 had deep vein thrombosis, 6 had pulmonary artery involvement, and 3 had arterial involvement. Twenty-nine patients started MMF after azathioprine due to adverse events such as leucopenia, gastrointestinal intolerance and elevation of liver enzymes. MMF was chosen in 2 patients because of concomitant use of warfarin, that may be problematic with azathioprine. The remaining 8 patients were treated with MMF due to active disease despite azathioprine. In 20/39 (50%) patients MMF was used concomitantly with biologics (infliximab in 15 and adalimumab in 5). One patient additionally used cyclosporine-A and 7 patients used low-dose prednisolone. At the end of follow-up, 33 of the patients were still using MMF. The reasons for MMF discontinuation were recurrent superficial thrombophlebitis in 3 patients with previous lower extremity deep vein thrombosis, fear from adverse events, desire of pregnancy and itching in 1 patient each. There were no serious adverse events or adverse events leading to discontinuation except for itching. None of the patients experienced exacerbation of mucocutaneous lesions during MMF treatment. Conclusion: MMF seems to be a safe and effective alternative especially when used for maintenance of remission or in addition to biologic agents in active patients with major organ involvement. Disclosure of Interests: Sinem Nihal Esatoglu: None declared, Emir Cemre: None declared, Vedat Hamuryudan Consultant for: Abbvie, Amgen, BMS, Jansen, MSD, Pfizer, UCB, Speakers bureau: Abbvie, Amgen, BMS, Jansen, MSD, Pfizer, UCB, Yilmaz Ozyazgan Speakers bureau: ABBVIE, Didar Ucar: None declared, Zekayi Kutlubay: None declared, Serdal Ugurlu: None declared, Emire Seyahi: None declared, Melike Melikoglu: None declared, Izzet Fresko: None declared, Sebahattin Yurdakul: None declared, Hasan Yazici: None declared, Gulen Hatemi Consultant for: Abbvie, Amgen, BMS, Janssen, MSD, Pfizer, UCB, Speakers bureau: Abbvie, Amgen, BMS, Jansen, MSD, Pfizer, UCB,