An evaluation of the usefulness of mycophenolate mofetil in pemphigus

Abstract

We found that MMF permitted a reduction in prednisolone dosage without disease relapse.

Mycophenolate Mofetil for the Management of Autoimmune Bullous Diseases

“…The patients given MMF showed faster and more durable responses, but the lack of difference in the response rate may have been attributable to the milder disease of the placebo group, which may not have needed the additional immunosuppressive therapy. Similarly to the results reported by Powell et al [ 59 ], the 2 and 3 g/day doses of MMF displayed similar effi cacy, but infectious adverse events were more frequent with the higher dose [ 63 ].…”

“…A few patients with paraneoplastic pemphigus were reported to benefi t from combined immunosuppressive regimens, including MMF and corticosteroids [ 59 ] or MMF, corticosteroids, and azathioprine [ 69 ].…”

“…The much lower doses of prednisone at the time of MMF initiation in this study are noteworthy and may explain the relatively low rate of clinical remission. MMF doses higher than 2 g/day were not associated with a better outcome, but increased the risk for opportunistic infections [ 59 ].…”

Multicenter Randomized, Double-blind, Placebo-Controlled, Clinical Trial of Dapsone as a Glucocorticoid-Sparing Agent in Maintenance-Phase Pemphigus Vulgaris

“…Participation in the study was discontinued if the patient's hemoglobin dropped below 9 g/dL; leukocyte level, below 1.9ϫ10 3 /mm 3 ; albumin, below 0.75 of the lower limit of the reference range; bilirubin (total), increased more than 4.9 times the upper limit of the reference range; serum glutamicoxaloacetic transaminase, increased more than 5.0 times the upper limit of the reference range; or alkaline phosphatase, increased 2.0 times the upper limit of the reference range; or if the patients had diarrhea with liquid stools or signs of dehydration, nausea, and vomiting more than 3 times a day; had clinical signs of dehydration; or if 3 ϩ proteinuria or 2 ϩ red blood cells in the urine were observed. Treatment was also to be discontinued if the patients developed peripheral neuropathy or psychosis.…”

“…1 Immunosuppressants, such as azathioprine, mycophenolate mofetil, and cyclophosphamide, are frequently used as GC-sparing agents, although to our knowledge only 1 controlled study using an oral adjuvant has been performed. [2][3][4][5][6][7][8][9][10][11] The clinical course and therapy of PV have 3 therapeutic phases. 1 High dosages of GC treatment achieve initial control of the acute disease during phase 1 (control).…”