Mycophenolate Risk Mitigation

CE / CME

Taking the Patient-Centered Approach to Mycophenolate Risk Mitigation

Pharmacists: 1.00 contact hour (0.1 CEUs)

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

Physicians: maximum of 1.00 AMA PRA Category 1 Credit

Nurses: 1.00 Nursing contact hour of which 1.00 are eligible for pharmacology credit

Released: February 25, 2025

Expiration: May 29, 2025

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Patient Case: Lisa (continued)

Watch this brief video to see what Lisa learned at her first meeting with her maternal–fetal medicine specialist.

Faculty Discussion

Jennifer Simpson, DNP:
Coordinating care between rheumatologists and OB/GYNs requires developing strong relationships and open lines of communication within the community. It is also important to set clear expectations with patients so they understand the significance of coordinated care. 

Dr Girnita, how do you incorporate nurse practitioners and physician associates into this care team strategy? 

Diana Girnita, MD, PhD:
Educating the entire care team, including nurse practitioners, physician associates, nurses, and medical assistants, about the risks associated with mycophenolate is very important. Patients must be reminded at every visit about the potential risks, especially regarding unplanned pregnancies. This consistent messaging from multiple HCPs helps ensure that patients receive and retain this education.

Jennifer Simpson, DNP:
That is great feedback. Dr Dolin, do you have any experience collaborating with pharmacists in these scenarios?

Cara D. Dolin, MD, MPH:
Pharmacists are definitely key members of the healthcare team. I often reach out to a pharmacist to clarify dosage, drug–drug interactions, and medication impacts during pregnancy and lactation. 

Jennifer Simpson, DNP:
Have you ever had a pharmacist reach out to you regarding a pregnancy-related issue with mycophenolate specifically? 

Cara D. Dolin, MD, MPH:
Not specifically with mycophenolate, but I am always available for pharmacists to reach out to me if they have any questions about a drug.

Jennifer Simpson, DNP:
Dr Girnita, have you ever had a pharmacist reach out to you about patients having an unplanned pregnancy? 

Diana Girnita, MD, PhD:
I have not, but I have occasionally had discussions with pharmacists to report potential drug–drug interactions, or they will ask my team whether a patient was educated about the pregnancy risks associated with the medications the patient is taking. 

Cara D. Dolin, MD, MPH:
Preconception referrals are invaluable, especially as a maternal–fetal medicine subspecialist. Seeing patients before they are pregnant is an opportunity for us to transition them to pregnancy-compatible medications and optimize their preconception health. For example, patients with lupus who conceive when their disease is quiescent experience much better pregnancy outcomes compared with those who conceive during disease flares. This also applies to many other autoimmune diseases. Early intervention ensures coordinated care, promotes optimal preconception health, and encourages adherence to prenatal vitamins with folic acid. These little things can make a huge difference for a healthy pregnancy. 

Mycophenolate Pregnancy Registry

It is very important to report any pregnancy that occurs when a patient is receiving mycophenolate treatment or within 6 weeks after discontinuation of the medication to the Mycophenolate Pregnancy Registry on the registry website. Patients should be informed about the reporting process, and they are likely to be open and supportive of participating.

Patients are encouraged to enroll directly in the registry themselves. It is important to reassure them that all the information is protected under the Health Insurance Portability and Accountability Act and remains confidential. The Mycophenolate Pregnancy Registry can be accessed online through the website provided on the slide or by calling the phone number shown on the slide.7

Additional HCP and Patient Educational Resources

Additional resources for both HCPs and patients are available on the Mycophenolate REMS website. Prescribers can access online training and obtain patient signatures on patient–prescriber acknowledgement forms. The website also has a place for voluntary reporting of mycophenolate pregnancy exposures to the Mycophenolate Pregnancy Registry, as previously discussed.

Further educational resources include the American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases21 and the American College of Obstetricians and Gynecologists clinical opinion article on different immunomodulatory therapies that can be used during pregnancy and lactation.22 The latter is a great resource when considering safe medication transitions for patients currently receiving mycophenolate.