TY - JOUR T1 - Case series reporting the effectiveness of mycophenolate mofetil in treatment-resistant asthma JF - European Respiratory Journal JO - Eur Respir J SP - 1134 LP - 1137 DO - 10.1183/09031936.00026413 VL - 42 IS - 4 AU - Christopher Grainge AU - Nivenka Jayasekera AU - Patrick Dennison AU - Hitasha Rupani AU - Ramesh Kurukulaaratchy AU - Peter Howarth Y1 - 2013/10/01 UR - http://erj.ersjournals.com/content/42/4/1134.abstract N2 - To the Editor:Treatment-resistant asthma represents a significant unmet clinical need. Due to lack of therapeutic options many patients receive treatment with long-term oral steroids despite appreciation of the associated systemic adverse effects. While anti-IgE therapy with omalizumab affords benefit and there have been encouraging outcomes with monoclonal antibodies against interleukin (IL)-5 and IL-13 [1, 2], all such treatments target T-helper cell type 2 (Th2) orientated disease in a sub-population of patients.Mycophenolate mofetil (MMF) is a reversible inhibitor of inosine monophosphate dehydrogenase, an enzyme required by T- and B-cells for guanine synthesis [3]. It is most commonly used to prevent transplanted organ rejection, but is increasingly prescribed to treat inflammatory disorders such as connective tissue disorders and systemic vasculitides.In January 2009, a patient in our institution with lifelong severe treatment-resistant asthma, poorly controlled despite high-dose inhaled corticosteroids, regular oral steroids and nebulised bronchodilators, was prescribed MMF for co-existent undifferentiated vasculitis. Over the following year his disease improved dramatically with a reduction in hospital admissions, enabling a reduction in oral steroids with a concurrent decrease in weight, improvement in quality of life and exercise capacity. In view of this experience, another individual with severe asthma resistant to all standard therapies was placed on MMF. This patient also showed a dramatic clinical improvement. Subsequently we treated a further 20 patients with MMF with varying results to give a case series of 22, which we report here.All patients started on MMF had been under specialist asthma care for at least 12 months and despite step 4 or 5 of asthma guidelines management had poor control, as measured by the asthma control questionnaire (ACQ), and … ER -