• Mycophenolic acid is a cytotoxic drug with genotoxic and clastogenic properties. It is an immunosuppressant used to prevent graft rejection after certain types of organ transplant. Mycophenolate mofetil is rapidly metabolised to mycophenolic acid in the body.
   
• About 50% of pregnancies exposed to mycophenolic acid during the first trimester end in spontaneous abortion. When the pregnancy continues, about 25% of the newborns have major malformations.
  
  
• Studies on paternal exposure have not ruled out a potential genotoxic effect on spermatozoa.
   
• In practice, given the risk of damage to gametes, it would be prudent for women to continue using effective contraception for at least 6 months after stopping treatment with mycophenolic acid before considering starting a pregnancy, and for men to do so for about 3 months. The alternatives come with a degree of uncertainty that must be handled on a case-by-case basis, with the involvement of the woman and couple concerned. 

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©Prescrire 1 September 2022

Source: "Mycophenolic acid and pregnancy: genotoxicity, malformations, spontaneous abortions" Prescrire International 2022; 31 (240): 210-213. Subscribers only.

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