***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background . Two open-label studies demonstrated that conversion from mycophenolate mofetil ( MMF ) to enteric-coated mycophenolate sodium ( EC-MPS ) significantly reduces gastrointestinal ( GI ) symptom burden and improves GI-specific health-related quality of life . Using a r and omized design , this study evaluated changes in GI symptoms and health-related quality of life in patients converted from MMF to EC-MPS versus patients who continued with MMF-based treatment . Methods . In this 4-week , multicenter , r and omized , prospect i ve , double-blind , parallel-group trial , renal transplant recipients with GI symptoms receiving MMF plus a calcineurin inhibitor±corticosteroids  were r and omized to an equimolar dose of EC-MPS+MMF placebo or continue on their MMF-based regimen+EC-MPS placebo . The primary efficacy outcome was a change from baseline in total Gastrointestinal Symptom Rating Scale score of a minimally important difference of more than or equal to 0.3 . Results . Three hundred ninety-six patients ( EC-MPS group : n=199 ; MMF group : n=197 ) were included . A greater proportion of EC-MPS patients ( 62 % ) reached the primary efficacy outcome compared with MMF patients ( 55 % ) ; however , the difference was not statistically significant ( P=0.15 ) . EC-MPS patients had a significantly greater decrease in the Gastrointestinal Symptom Rating Scale indigestion syndrome dimension versus MMF patients . Within the subgroups of patients with diabetes , patients transplanted 6 to 12 months of study enrollment , and patients on steroids , a statistically significant greater proportion of EC-MPS versus MMF patients reached the primary efficacy outcome . Conclusions . Conversion from MMF to EC-MPS may be associated with improvements in presence and severity of GI symptoms , particularly in patients with indigestion , diabetes , on steroids , and in patients converted between 6 and 12 months posttransplantation Background . The benefit of conversion from mycophenolate mofetil ( MMF ) to enteric-coated mycophenolate sodium ( EC-MPS ) in terms of gastrointestinal symptom burden has been evaluated previously using patient-reported outcomes . However , data are lacking concerning the sustained effect of conversion over time , and the potential impact of concomitant calcineurin inhibitor . Methods . In this 3-month , prospect i ve , multicenter , longitudinal , open-label trial , MMF-treated renal transplant patients with gastrointestinal symptoms receiving cyclosporine or tacrolimus were converted to equimolar doses of EC-MPS . Change in gastrointestinal symptom burden was evaluated using a vali date d Gastrointestinal Symptom Rating Scale ( GSRS ) . Results . A significant improvement in GSRS score was observed from baseline ( 2.61 , 95 % CI 2.54–2.68 ) to month 1 ( 1.87 , 95 % CI 1.81–1.93 ) after conversion to EC-MPS and was sustained to month 3 ( 1.81 , 95 % CI 1.74–188 ; both P<0.0001 versus baseline ) . The mean change in overall GSRS score from baseline to month 1 was −0.74 overall ( cyclosporine : −0.73 and tacrolimus : −0.74 ; all P<0.0001 versus baseline ) , with a slight further improvement ( −0.79 ) at month 3 ( cyclosporine : −0.82 and tacrolimus : −0.78 ; all P<0.0001 versus baseline ) . A significant improvement in GSRS subscale scores was also observed in the total population regardless of calcineurin inhibitor at month 1 , sustained to month 3 ( all P<0.0001 versus baseline ) . The improvement in GSRS score postconversion was similar in African-American and non-African-American patients , and in diabetic and nondiabetic patients . Conclusions . This exploratory study in 728 patients demonstrates that following conversion from MMF to EC-MPS , regardless of concomitant calcineurin inhibitor , GSRS is improved and sustained over 3 months OBJECTIVE To evaluate improvement in gastrointestinal ( GI ) symptoms and health-related quality of life ( HRQoL ) in liver transplant recipients switched from mycophenolate mofetil ( MMF ) to enteric-coated mycophenolate sodium ( EC-MPS ) . METHODS A multicenter , open-label , single-arm study was undertaken in maintenance liver transplant recipients who reported GI complications with MMF therapy . The patients were switched to equimolar doses of EC-MPS at baseline . The primary end point was the change in the Gastrointestinal Symptom Rating Scale ( GSRS ) total score after 6 to 8 weeks of treatment with EC-MPS . Other key assessment s for GI symptoms and HRQoL included the GSRS subscores , the Gastrointestinal Quality of Life Index ( GIQLI ) , the Psychological General Well-Being Index , and the Overall Treatment Effect ( OTE ) . Paired t-test was used to assess the difference in the mean score changes over time . RESULTS A total of 34 patients were enrolled and switched to equimolar doses of EC-MPS . After 6 to 8 weeks of EC-MPS  treatment , mean GSRS total score improved significantly from 2.88 ± 0.66 to 2.10 ± 0.78 . Mean improvement in GSRS total score ( -0.77 score points ; P = .001 ) exceeded the minimal clinical ly important difference . Significant improvements were observed in all GSRS subscales ( P < .05 ) , GIQLI total scores ( P = .001 ) , and GIQLI subscales " GI symptoms " ( P < .001 ) and " physical function " ( 0.013 ) . Patients who continued EC-MPS reported sustained benefits compared with patients who switched back to MMF after 6 to 8 weeks of treatment with EC-MPS . On the OTE scale , improvement in symptoms was reported in 76.5 % and 61.8 % of the patients as perceived by the physicians and the patients . Improvement in HRQoL was reported by 41.2 % of the patients . No deaths , biopsy proven acute rejections , or graft losses were reported during the study . CONCLUSION Conversion from MMF to EC-MPS was associated with a significant improvement in GI symptoms and HRQoL in liver transplant recipients BACKGROUND Gastrointestinal ( GI ) disorders are one of the main adverse events in patients treated by mycophenolic acid ( MPA ) .  The aim of our prospect i ve question naire-based study was to assess GI side-effects in de novo renal-transplant patients receiving either mycophenolate mofetil ( MMF ) or enteric-coated mycophenolate sodium ( EC-MPS ) .  METHODS Between January 2002 and April 2003 , all patients receiving MPA with a functioning allograft at 1 month post-transplantation were enrolled in this study ( n = 130 ) . Ninety-three of them received MMF  ( group I ) , and 37 patients received EC-MPS  ( group II ) . Each month , every patient completed a question naire regarding GI disorders . RESULTS During the first year post-transplantation , GI disorders occurred in 31 patients from the MMF group ( 33.3 % ) and 12 patients from the EC-MPS group ( 32.4 % ) ( not significant ) . The incidence of upper GI disorders was also similar in both groups . Diarrhoea was observed in 18 patients ( 19.3 % ) from group I , and in five patients from group II ( 13.5 % ) ( not significant ) . Its frequency and severity were similar in both groups . Weight loss was observed in three patients receiving MMF .  Diarrhoea resolved spontaneously in 10 patients from group I and in all patients from group II . For the other eight patients in group I , the diarrhoea required MMF discontinuation in three patients and dose reduction in five patients . CONCLUSIONS In conclusion , in this question naire-based evaluation , the incidence of GI disorders was similar in patients receiving either MMF or EC-MPS during the first year post-transplantation Abstract : Background : Post‐transplant gastrointestinal ( GI ) side effects can impair a patient ’s quality of life ( QoL ) . This study investigates the improvement in GI side effects and related QoL changes in recipients of liver transplantation ( OLT ) after converting patients from mycophenolate mofetil ( MMF ) to enteric‐coated mycophenolate sodium ( EC‐MPS ) Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more It is reported that a conversion from mycophenolate mofetil ( MMF ) to enteric-coated mycophenolate sodium ( EC-MPS ) relieves gastrointestinal ( GI ) symptom burden and improves health-related quality of life ( HRQoL ) . However , it is unclear whether renal transplant recipients using tacrolimus  receive the same benefit from the conversion . In this prospect i ve , multi-center , open-label trial , patients were categorized into two groups by their GI symptom screening . Equimolar EC-MPS ( n=175 ) was prescribed for patients with GI burdens ; those with no complaints remained on MMF ( n=83 ) . Gastrointestinal Symptom Rating Scale ( GSRS ) and Gastrointestinal Quality of Life Index ( GIQLI ) were evaluated at baseline and after one month . Patients and physicians completed Overall Treatment Effect ( OTE ) at one month .  EC-MPS-converted  patients had worse GSRS and GIQLI scores at baseline than MMF-continued patients ( all P<0.001 ) . Significant improvements in GSRS and GIQLI scores were observed for EC-MPS-converted patients at one month , but MMF-continued patients showed worsened GSRS scores ( all P<0.05 ) . OTE scale indicated that EC-MPS patients improved in overall GI symptoms and HRQoL more than MMF patients did ( P<0.001 ) . In  tacrolimus-treated renal transplant recipients with GI burdens , a conversion from MMF to EC-MPS improves GI-related symptoms and Conversion from MMF to EC-MPS may reduce GI complications and permit increased MPA dosing with a concomitant reduction in CNI dose . In a prospect i ve trial , paediatric renal transplant patients with stable graft function were converted from MMF to EC-MPS and followed-up for 12 months . Data from 28 patients ( mean age 13.9 + /- 3.1 yr ) were available for analysis . Mean EC-MPS dose increased significantly from conversion to month 12 ( 668 + /- 81 mg/m(2)/day vs. 747 + /- 98 mg/m(2)/day , p < 0.001 ) .  CsA-ME dose ( n = 23 ) decreased from 5.3 + /- 1.7 mg/kg/day at conversion to 4.6 + /- 1.4 mg/kg/day at month 12 ( p = 0.010 ) . cGFR increased from 69.5 + /- 23.3 mL/min/1.73 m(2 ) at the time of conversion to 80.7 + /- 30.7 mL/min/1.73 m(2 ) at month 12 ( p = 0.007 ) . The number of patients reporting at least one GI event during six months prior to conversion was 15/28 ( 53.6 % ) , declining to 8/28 ( 28.6 % ) at month 6 post-conversion and 5/28 ( 17.8 % ) at month 12 . This single-arm study suggests that conversion of paediatric renal transplant patients from MMF to EC-MPS does not compromise efficacy and leads to improved GI tolerability . MPA dose increased and  CsA-ME dose decreased significantly , with an associated improvement in calculated GFR . A large-scale controlled trial is required to confirm these promising findings OBJECTIVE Gastrointestinal discomfort is one of the main adverse events in patients treated with mycophenolic acid ( MPA ) .  The aim of this prospect i ve study was to evaluate the effect of conversion from mycophenolate mofetil ( MMF ) to enteric-coated mycophenolate sodium ( EC-MPS ) in liver transplant patients with gastrointestinal side effects . MATERIAL S AND METHODS A single center , open-label , single arm , prospect i ve study was undertaken in previous MMF-treated liver transplant patients who stopped MMF due to gastrointestinal side effects . Patients were rechallenged with the same dose of MMF which previously provoked the discomfort . Subsequently , patients with gastrointestinal complaints were switched from MMF ( mean dose , 1325 mg [ interquartile range ( IQR ) , 750 - 2000 mg ] ) to equimolar doses of EC-MPS ( mean dose , 858 mg [ IQR , 525 - 1170 mg ] ) . RESULTS Twelve patients received a rechallenge and 10 patients 
    Output:
    
The consoli date d results of the three studies with low risk of bias suggest no evidence to convert patients stabilised on MMF .