Impact of Proton Pump Inhibitors on Disease Progression in Autoimmune Myasthenia Gravis Patients Treated with Mycophenolate Mofetil (P02.190)

OBJECTIVE: To determine if proton pump inhibitors (PPI) impact the clinical course of autoimmune myasthenia gravis (AI MG) in patients treated with mycophenolate mofetil. BACKGROUND: Mycophenolate Mofetil (MM) is a widely used in treating autoimmune myasthenia gravis. Recent evidence suggests that proton pump inhibitors may interfere with mycophenolate mofetil9s absorption. MM is cleaved in the stomach9s acidic environment, which is an essential prerequisite for proper absorption. PPI increase the pH of the stomach, thereby interfering with proper absorption of MM. DESIGN/METHODS: This is a retrospective chart review of patients receiving treatment for myasthenia gravis between 2007 and 2012 at the University of Connecticut. 160 charts were examined to determine eligibility for the study. Eligible patients were stratified into two groups, younger than 55 years of age and older than 55 years of age. Patients prescribed mycophenolate mofetil and a proton pump inhibitor were treated as the experimental group, while patients receiving other therapy were treated as a control. Each patient chart was then analyzed to determine the number of hospitalizations/exacerbations in each group. RESULTS: There were a total of 106 patient charts analyzed in detail during this study. The median age of patients was 70; male patients 73.9 and female patients 68.7. No patients less than 55 y/o who were on MM and PPI required hospitalization. Patients older than 55 y/o age when treated with MM and PPI accounted for about 20% of the total hospitalizations. The study is limited by the relatively low number of patients treated with MM at our institution. CONCLUSIONS: There appears to be a disproportionate represantation of hospitalized patients older than 55 y/o age treated with MM and PPI. Further studies are on the way to include more patients and to include analysis of other comorbidities and medications that may influence the number of hospitalizations in patients with AI MG. Disclosure: Dr. Mahlstedt has nothing to disclose. Dr. Waitzman has nothing to disclose. Dr. Jani-Acsadi has nothing to disclose.