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SATURDAYOctober 16RAPID FIRE
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P. Regine Mydlarski Introduced in the 1970s for the treatment of psoriasis, mycophenolic acid has since been reformulated as CellCept ® (mycophenolate mofetil or MMF). With an improved side effect profile and better bioavailability, MMF is a promising new drug for immune-mediated skin disease. A noncompetitive inhibitor of inosine monophosphate dehydrogenase (IMPDH), it inhibits de novo purine synthesis. As lymphocytes rarely use the salvage pathway for purine synthesis, MMF has potent cytostatic effects on T and B cells. Through these actions, MMF blocks lymphocyte proliferation and antibody formation. Typically dosed at 2-3 g/day, MMF is generally well tolerated. Common symptoms include: headache, nausea, stomach upset, vomiting, diarrhea, urinary frequency and urgency. There is no increase in nephrotoxicity, hepatotoxicity, hypertension, or neurotoxicity when MMF is used in conjunction with cyclosporin and corticosteroids. Potentially less mutagenic than azathioprine, MMF may have a lower risk of carcinogenicity. However, it may take several years for this advantage to be substantiated. Approved for the prevention of organ rejection, the list of “off-label” uses continues to grow. Potential dermatolgic uses include: psoriasis, atopic dermatitis, bullous disease, lichen planus, pyoderma gangrenosum, sarcoidosis, Behçet's disease, Crohn's disease, erythema multiforme, graft-versus-host disease and connective tissue disease such as lupus erythematosus and dermatomyositis. As MMF has only recently been re-introduced into the field of dermatology, case reports and case series dominate the literature. Preliminary results are sufficiently promising to warrant larger, randomized clinical trials with this new and emerging therapy.
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