Vol. 1 No. 1 (2025), Original Article
Vol. 1 No. 1 (2025)

Mycophenolate Mofetil for the Treatment of Resistant Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Original Article
Published 2025-03-13
Natalie Balassiano
Department of Internal Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals Queens, New York, NY, USA. image/svg+xml
https://orcid.org/0000-0003-2476-0218
Jasmine Tidwell
Department of Internal Medicine, University of Connecticut, Farmington, CT, USA. image/svg+xml
https://orcid.org/0009-0004-0560-672X
Omar Abdelhalim
Department of Internal Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals Queens, New York, NY, USA. image/svg+xml
Mohammed Abusuliman
Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA. image/svg+xml
Mahmoud Nassar
Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA. image/svg+xml
Azizullah Beran
Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN, USA. image/svg+xml
Ivan Cancarevic
Department of Medicine, Brigham and Women’s Hospital and Massachusetts General Hospital, Boston, MA, USA. image/svg+xml
https://orcid.org/0000-0002-7455-6381
Hazem Abosheaishaa
Department of Internal Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals Queens, New York, NY, USA. image/svg+xml
https://orcid.org/0000-0002-5581-8702
forest plot
PDF

Keywords

Mycoohenolate Mofetil
Inflammatory bowel disease
Crohn's disease
Ulcerative colitis
systematic review
Meta-analysis

How to Cite

1.
Balassiano N, Tidwell J, Abdelhalim O, et al. Mycophenolate Mofetil for the Treatment of Resistant Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. ASIDE GI. 2025;1(1):15-22. doi:10.71079/ASIDE.GI.03132515
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver AMA

Download Citation

Endnote/Zotero/Mendeley (RIS) BibTeX

Abstract

Background: This systematic review evaluates the efficacy and safety of Mycophenolate Mofetil (MMF) for managing treatment‐resistant Inflammatory Bowel Disease (IBD), emphasizing remission rates and adverse effects.

Methods: Observational and controlled trials assessing MMF’s impact on IBD were included, excluding non-English and pediatric studies. Comprehensive searches were conducted in Embase, Medline/PubMed, Scopus, and Web of Science through October 2023. The risk of bias was evaluated using the NIH quality assessment tool, and results were synthesized using a random-effects meta-analysis model.

Results: Twelve studies comprising 446 participants (333 with Crohn’s disease and 113 with ulcerative colitis) were analyzed. The meta-analysis revealed remission rates of 62.2% at 8 weeks and 52.8% at 6 months. Adverse effects occurred in 26.1% of patients, with nausea and vomiting being most common. Treatment discontinuation due to failure and intolerance was observed in 29.7% and 20% of cases, respectively.

Discussion: The findings suggest that MMF effectively induces remission in IBD patients unresponsive to conventional therapies, although a notable proportion experienced adverse events or treatment failure. Careful patient selection and monitoring are essential.

Conclusion: MMF presents a promising alternative for managing resistant IBD, but its adverse effect profile warrants cautious application. Further research is needed to optimize dosing strategies and assess long-term outcomes in this challenging patient population. These results underscore the potential of MMF as an effective therapeutic option, while emphasizing the importance of individualized treatment plans and rigorous clinical monitoring. Future studies should focus on long-term safety, dosing. Additional robust research is required.

PDF

References

1. Zhang YZ, Li YY. Inflammatory bowel disease: pathogenesis. World J Gastroenterol. 2014: 91 [PMID: 24415861 https://doi.org/10.3748/wjg.v20.i1.91]

2. Moazzami B, Moazzami K, Rezaei N. Early onset inflammatory bowel disease: manifestations, genetics and diagnosis. Turk J Pediatr. 2019: 637 [PMID: 32104994 https://doi.org/10.24953/turkjped.2019.05.001]

3. Rodrigues BL, Mazzaro MC, Nagasako CK, Ayrizono MLS, Fagundes JJ, Leal RF. Assessment of disease activity in inflammatory bowel diseases: Non-invasive biomarkers and endoscopic scores. World J Gastrointest Endosc. 2020: 504 [PMID: 33362904 https://doi.org/10.4253/wjge.v12.i12.504]

4. Rothfuss KS, Stange EF, Herrlinger KR. Extraintestinal manifestations and complications in inflammatory bowel diseases. World J Gastroenterol. 2006: 4819 [PMID: 16937463 https://doi.org/10.3748/wjg.v12.i30.4819]

5. Kim ER, Chang DK. Colorectal cancer in inflammatory bowel disease: the risk, pathogenesis, prevention and diagnosis. World J Gastroenterol. 2014: 9872 [PMID: 25110418 https://doi.org/10.3748/wjg.v20.i29.9872]

6. Chakrabarti K, Frame D, Al Abbas M, McCune WJ. The use of mycophenolate mofetil area under the curve. Curr Opin Rheumatol. 2021: 221 [PMID: 33741807 https://doi.org/10.1097/BOR.0000000000000799]

7. Orvis AK, Wesson SK, Breza TS, Jr., Church AA, Mitchell CL, Watkins SW. Mycophenolate mofetil in dermatology. J Am Acad Dermatol. 2009: 183 [PMID: 19150270 https://doi.org/10.1016/j.jaad.2008.08.049]

8. Surjushe A, Saple DG. Mycophenolate mofetil. Indian J Dermatol Venereol Leprol. 2008: 180 [PMID: 18388396 https://doi.org/10.4103/0378-6323.39725]

9. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010: 336 [PMID: 20171303 https://doi.org/10.1016/j.ijsu.2010.02.007]

10. Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, Thomas J. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev. 2019: ED000142 [PMID: 31643080 https://doi.org/10.1002/14651858.ED000142]

11. Murray A, Nguyen TM, Parker CE, Feagan BG, MacDonald JK. Oral 5-aminosalicylic acid for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2020: CD000543 [PMID: 32786164 https://doi.org/10.1002/14651858.CD000543.pub5]

12. Bruscoli S, Febo M, Riccardi C, Migliorati G. Glucocorticoid Therapy in Inflammatory Bowel Disease: Mechanisms and Clinical Practice. Front Immunol. 2021: 691480 [PMID: 34149734 https://doi.org/10.3389/fimmu.2021.691480]

13. Jeong DY, Kim S, Son MJ, Son CY, Kim JY, Kronbichler A, Lee KH, Shin JI. Induction and maintenance treatment of inflammatory bowel disease: A comprehensive review. Autoimmun Rev. 2019: 439 [PMID: 30844556 https://doi.org/10.1016/j.autrev.2019.03.002]

14. Lee LYW, Gardezi AS, Santharam V, Boyd J, Lanzon-Miller S. Effect of azathioprine intolerance on outcomes of inflammatory bowel disease: a cross-sectional study. Frontline Gastroenterol. 2014: 40 [PMID: 28839749 https://doi.org/10.1136/flgastro-2013-100348]

15. Hassard PV, Vasiliauskas EA, Kam LY, Targan SR, Abreu MT. Efficacy of mycophenolate mofetil in patients failing 6-mercaptopurine or azathioprine therapy for Crohn's disease. Inflamm Bowel Dis. 2000: 16 [PMID: 10701145 https://doi.org/10.1097/00054725-200002000-00003]

16. Ford AC, Towler RJ, Moayyedi P, Chalmers DM, Axon AT. Mycophenolate mofetil in refractory inflammatory bowel disease. Aliment Pharmacol Ther. 2003: 1365 [PMID: 12786630 https://doi.org/10.1046/j.1365-2036.2003.01581.x]

17. Fickert P, Hinterleitner TA, Wenzl HH, Aichbichler BW, Petritsch W. Mycophenolate mofetil in patients with Crohn's disease. Am J Gastroenterol. 1998: 2529 [PMID: 9860419 https://doi.org/10.1111/j.1572-0241.1998.00606.x]

18. Miehsler W, Reinisch W, Moser G, Gangl A, Vogelsang H. Is mycophenolate mofetil an effective alternative in azathioprine-intolerant patients with chronic active Crohn's disease? Am J Gastroenterol. 2001: 782 [PMID: 11280551 https://doi.org/10.1111/j.1572-0241.2001.03622.x]

19. Fellermann K, Steffen M, Stein J, Raedler A, Hamling J, Ludwig D, Loeschke K, Stange EF. Mycophenolate mofetil: lack of efficacy in chronic active inflammatory bowel disease. Aliment Pharmacol Ther. 2000: 171 [PMID: 10651657 https://doi.org/10.1046/j.1365-2036.2000.00695.x]

20. Lim SZ, Chua EW. Revisiting the Role of Thiopurines in Inflammatory Bowel Disease Through Pharmacogenomics and Use of Novel Methods for Therapeutic Drug Monitoring. Front Pharmacol. 2018: 1107 [PMID: 30349479 https://doi.org/10.3389/fphar.2018.01107]

21. Velikova T, Sekulovski M, Peshevska-Sekulovska M. Immunogenicity and Loss of Effectiveness of Biologic Therapy for Inflammatory Bowel Disease Patients Due to Anti-Drug Antibody Development. Antibodies (Basel). 2024: [PMID: 38534206 https://doi.org/10.3390/antib13010016]

22. Smith MR, Cooper SC. Mycophenolate mofetil therapy in the management of inflammatory bowel disease--a retrospective case series and review. J Crohns Colitis. 2014: 890 [PMID: 24507162 https://doi.org/10.1016/j.crohns.2014.01.014]

23. Neurath MF, Wanitschke R, Peters M, Krummenauer F, Meyer zum Buschenfelde KH, Schlaak JF. Randomised trial of mycophenolate mofetil versus azathioprine for treatment of chronic active Crohn's disease. Gut. 1999: 625 [PMID: 10205197 https://doi.org/10.1136/gut.44.5.625]

24. Palaniappan S, Ford AC, Greer D, Everett SM, Chalmers DM, Axon AT, Hamlin PJ. Mycophenolate mofetil therapy for refractory inflammatory bowel disease. Inflamm Bowel Dis. 2007: 1488 [PMID: 17924566 https://doi.org/10.1002/ibd.20258]

25. Macaluso FS, Maida M, Renna S, Orlando E, Affronti M, Sapienza C, Dimarco M, Orlando R, Rizzuto G, Cottone M, Orlando A. Mycophenolate mofetil is a valid option in patients with inflammatory bowel disease resistant to TNF-alpha inhibitors and conventional immunosuppressants. Dig Liver Dis. 2017: 157 [PMID: 27876682 https://doi.org/10.1016/j.dld.2016.10.001]

26. Hernandez-Camba A, Arranz L, Vera I, Carpio D, Calafat M, Lucendo AJ, Taxonera C, Marin S, Garcia MJ, Marin GS, Rodriguez ES, Carbajo AY, De Castro ML, Iborra M, Martin-Cardona A, Rodriguez-Lago I, Busquets D, Bertoletti F, Ausin MS, Tardillo C, Malaves JH, Bujanda L, Castano A, Domenech E, Ramos L, Geteccu, Additional member of the Spanish Gg. Real-world use of mycophenolate mofetil in inflammatory bowel disease: Results from the ENEIDA registry. Dig Liver Dis. 2022: 635 [PMID: 34862115 https://doi.org/10.1016/j.dld.2021.10.002]

27. Orth T, Peters M, Schlaak JF, Krummenauer F, Wanitschke R, Mayet WJ, Galle PR, Neurath MF. Mycophenolate mofetil versus azathioprine in patients with chronic active ulcerative colitis: a 12-month pilot study. Am J Gastroenterol. 2000: 1201 [PMID: 10811328 https://doi.org/10.1111/j.1572-0241.2000.02010.x]

28. Tan T, Lawrance IC. Use of mycophenolate mofetil in inflammatory bowel disease. World J Gastroenterol. 2009: 1594 [PMID: 19340901 https://doi.org/10.3748/wjg.15.1594]

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2025 ASIDE Gastroenterology

Most read articles by the same author(s)

Similar Articles

You may also start an advanced similarity search for this article.