{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T06:45:14Z","timestamp":1792565114320,"version":"4.5.0"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Muscle and Nerve"],"abstract":"ABSTRACT<\/jats:title>\n \n Introduction\/Aims<\/jats:title>\n Evidence linking serum mycophenolic acid (MPA) concentrations with safety outcomes in myasthenia gravis (MG) is limited. We evaluated whether single serum MPA concentrations were associated with clinically documented infection.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This retrospective study included acetylcholine receptor antibody\u2010positive MG patients treated with mycophenolate mofetil (MMF) for at least 1\u2009year who had MPA and mycophenolic acid glucuronide (MPAG) measurement with same\u2010day complete blood count testing. Exact sampling time relative to MMF dosing was not uniformly documented; therefore, values were analyzed as single serum concentrations rather than confirmed trough levels.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 112\u2009MMF\u2010treated patients, 60 had MPA\/MPAG measurement, and 10 had recent infection. Serum MPA concentration correlated strongly and positively with MPAG concentration (\n r<\/jats:italic>\n \u2009=\u20090.717) and moderately and inversely with lymphocyte count (\n r<\/jats:italic>\n \u2009=\u2009\u22120.406). Infection occurred in 0\/18 low, 2\/24 intermediate, and 8\/18 high MPA concentration groups. Patients with infection had higher MPA concentration (median 6.15 vs. 1.80\u2009\u03bcg\/mL; Bonferroni\u2010adjusted\n p<\/jats:italic>\n \u2009=\u20090.032) and higher MPA concentration per prescribed MMF dose.\n <\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n Higher single serum MPA concentrations were associated with recent infection. Prospective controlled studies including patients not treated with MMF are needed.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/mus.70428","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T06:08:13Z","timestamp":1792562893000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Serum Mycophenolic Acid Levels and Infection Risk in Myasthenia Gravis"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9526-6877","authenticated-orcid":false,"given":"Gyeong Mo","family":"Sohn","sequence":"first","affiliation":[{"name":"Department of Neurology Haeundae\u2010Paik Hospital, Inje University Busan South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1349-1913","authenticated-orcid":false,"given":"Kyong Jin","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Neurology Haeundae\u2010Paik Hospital, Inje University Busan South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"issue":"26","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"2570","DOI":"10.1056\/NEJMra1602678","article-title":"Myasthenia Gravis","volume":"375","author":"Gilhus N. E.","year":"2016","journal-title":"New England Journal of Medicine"},{"issue":"1","key":"e_1_2_10_3_1","first-page":"16","article-title":"Myasthenia Gravis: Recommendations for Clinical Research Standards","volume":"55","author":"Jaretzki A.","year":"2000","journal-title":"Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Neurology"},{"issue":"4","key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"173","DOI":"10.3988\/jcn.2011.7.4.173","article-title":"Treatment of Myasthenia Gravis Based on Its Immunopathogenesis","volume":"7","author":"Kim J. Y.","year":"2011","journal-title":"Journal of Clinical Neurology"},{"issue":"3","key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"340","DOI":"10.3988\/jcn.2016.12.3.340","article-title":"Incidence and Prevalence of Myasthenia Gravis in Korea: A Population\u2010Based Study Using the National Health Insurance Claims Database","volume":"12","author":"Park S. Y.","year":"2016","journal-title":"Journal of Clinical Neurology"},{"issue":"8","key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1186\/2047-783X-14-8-364","article-title":"Mycophenolate Mofetil as Second Line Immunosuppressant in Myasthenia Gravis\u2014A Long\u2010Term Prospective Open\u2010Label Study","volume":"14","author":"Hanisch F.","year":"2009","journal-title":"European Journal of Medical Research"},{"issue":"5","key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1002\/mus.21640","article-title":"Mycophenolate Mofetil in AChR\u2010Antibody\u2010Positive Myasthenia Gravis: Outcomes in 102 Patients","volume":"41","author":"Hehir M. K.","year":"2010","journal-title":"Muscle & Nerve"},{"issue":"2","key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1097\/CND.0000000000000375","article-title":"Retrospective Analysis of Mycophenolate Mofetil in Generalized Myasthenia Gravis","volume":"23","author":"Khosa S.","year":"2021","journal-title":"Journal of Clinical Neuromuscular Disease"},{"issue":"12","key":"e_1_2_10_9_1","doi-asserted-by":"crossref","first-page":"1744","DOI":"10.2215\/CJN.0000000824","article-title":"Effectiveness of Mycophenolate Mofetil Trough Level Monitoring in Children With Relapsing Nephrotic Syndrome","volume":"20","author":"Morello W.","year":"2025","journal-title":"Clinical Journal of the American Society of Nephrology"},{"issue":"6","key":"e_1_2_10_10_1","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1212\/01.wnl.0000312373.67493.7f","article-title":"A Trial of Mycophenolate Mofetil With Prednisone as Initial Immunotherapy in Myasthenia Gravis","volume":"71","author":"Muscle Study Group","year":"2008","journal-title":"Neurology"},{"issue":"3","key":"e_1_2_10_11_1","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/S1474-4422(24)00028-0","article-title":"Comparative Effectiveness of Azathioprine and Mycophenolate Mofetil for Myasthenia Gravis (PROMISE\u2010MG): A Prospective Cohort Study","volume":"23","author":"Narayanaswami P.","year":"2024","journal-title":"Lancet Neurology"},{"issue":"6","key":"e_1_2_10_12_1","doi-asserted-by":"crossref","first-page":"581","DOI":"10.3988\/jcn.2025.0308","article-title":"Effective Subcutaneous Efgartigimod Treatment in a 90\u2010Year\u2010Old Female With Myasthenia Gravis","volume":"21","author":"Nosaki Y.","year":"2025","journal-title":"Journal of Clinical Neurology"},{"issue":"2","key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1002\/mus.70105","article-title":"Prognosis After Discontinuation of Azathioprine or Mycophenolate Mofetil in Well\u2010Controlled Myasthenia Gravis: A Retrospective Analysis","volume":"73","author":"Ozer I. S.","year":"2026","journal-title":"Muscle & Nerve"},{"issue":"5","key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1212\/WNL.0000000000003570","article-title":"Author Response: International Consensus Guidance for Management of Myasthenia Gravis: Executive Summary","volume":"88","author":"Sanders D. B.","year":"2017","journal-title":"Neurology"},{"issue":"3","key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1212\/WNL.0000000000011124","article-title":"International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update","volume":"96","author":"Narayanaswami P.","year":"2021","journal-title":"Neurology"},{"issue":"8","key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1097\/TP.0b013e318186f98a","article-title":"Comparing Mycophenolate Mofetil Regimens for De Novo Renal Transplant Recipients: The Fixed\u2010Dose Concentration\u2010Controlled Trial","volume":"86","author":"Gelder T.","year":"2008","journal-title":"Transplantation"},{"issue":"5","key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1002\/mus.21142","article-title":"Comparison of Outcome Measures From a Trial of Mycophenolate Mofetil in Myasthenia Gravis","volume":"38","author":"Wolfe G. I.","year":"2008","journal-title":"Muscle & Nerve"},{"issue":"5","key":"e_1_2_10_18_1","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.2215\/CJN.03861106","article-title":"Therapeutic Drug Monitoring of Mycophenolic Acid","volume":"2","author":"Shaw L. M.","year":"2007","journal-title":"Clinical Journal of the American Society of Nephrology"},{"issue":"1","key":"e_1_2_10_19_1","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/S0009-9120(00)00184-3","article-title":"Pharmacokinetic, Pharmacodynamic, and Outcome Investigations as the Basis for Mycophenolic Acid Therapeutic Drug Monitoring in Renal and Heart Transplant Patients","volume":"34","author":"Shaw L. M.","year":"2001","journal-title":"Clinical Biochemistry"},{"issue":"5","key":"e_1_2_10_20_1","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/S0009-9120(98)00050-2","article-title":"Analysis, Pharmacokinetics and Therapeutic Drug Monitoring of Mycophenolic Acid","volume":"31","author":"Shaw L. M.","year":"1998","journal-title":"Clinical Biochemistry"},{"issue":"7","key":"e_1_2_10_21_1","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1212\/WNL.52.7.1487","article-title":"Myasthenia Gravis Activities of Daily Living Profile","volume":"52","author":"Wolfe G. I.","year":"1999","journal-title":"Neurology"},{"issue":"5","key":"e_1_2_10_22_1","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1213\/ANE.0000000000002864","article-title":"Correlation Coefficients: Appropriate Use and Interpretation","volume":"126","author":"Schober P.","year":"2018","journal-title":"Anesthesia and Analgesia"}],"container-title":["Muscle & Nerve"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mus.70428","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/mus.70428","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mus.70428","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T06:08:16Z","timestamp":1792562896000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/mus.70428"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,20]]},"references-count":21,"alternative-id":["10.1002\/mus.70428"],"URL":"https:\/\/doi.org\/10.1002\/mus.70428","archive":["Portico"],"relation":{},"ISSN":["0148-639X","1097-4598"],"issn-type":[{"value":"0148-639X","type":"print"},{"value":"1097-4598","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,20]]},"assertion":[{"value":"2026-02-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"mus.70428"}}