Mycophenolate Mofetil as an Effective Corticosteroid-Sparing Therapy for Recalcitrant Dermatomyositis

Abstract

Background: Dermatomyositis (DM) is a multisystem idiopathic inflammatory disorder that most commonly affects the muscles and skin. Systemic corticosteroids are the mainstay of therapy but are limited by their longterm adverse effects.Observations: We sought to evaluate the effectiveness of oral mycophenolate mofetil in patients with cutaneous lesions of DM recalcitrant to other therapies through an open-label retrospective medical chart review of patients in a university-affiliated private practice setting. Twelve patients with DM who had skin lesions recalcitrant to traditional therapies or who developed toxic effects from traditional therapies began mycophenolate mofetil treatment at doses ranging from 500 mg to 1 g twice a day. Response was based on improvement in skin disease as judged clinically, an increase in strength, and/or an ability to decrease or discontinue concomitant therapies. Improvement was seen in 10 of the 12 patients, most within 4 to 8 weeks. Most patients tolerated mycophenolate mofetil treatment without problem; however, 1 patient developed a B-cell lymphoma of the central nervous system, and another developed abnormal levels of hepatic enzymes along with urinary symptoms. Resolution of these toxic reactions occurred with cessation of mycophenolate mofetil treatment in each patient. Conclusion:Mycophenolate mofetil may be an effective corticosteroid-sparing therapy for the treatment of some patients with DM.

Mycophenolate mofetil in juvenile dermatomyositis: a case series

“…Patient 4 presented on the 12th month of treatment a transient neutropenia (750/mm 3 ) during a viral infection, while he was concomitantly taking methotrexate. [8,9]. However, no controlled trial is available, and experience in adult myositis remains limited.…”

Mycophenolate mofetil therapy for juvenile dermatomyositis with immune thrombocytopenic purpura

“…MMF has recently been used widely in the treatment of autoimmune diseases, mainly lupus nephritis, with relatively few serious adverse effects. Some studies have also suggested its effectiveness for the muscle weakness and cutaneous symptoms of adult polymyositis/dermatomyositis [20][21][22], as well as its effectiveness in JDM [23]. In our department, we are currently treating 4 JDM patients, including the present one, with MMF.…”

Special papers Diagnostic and therapeutic advances in dermatomyositis

“…W badaniach analizujących serie przypadków i w badaniach klinicznych w małych grupach pacjentów MMF w dawce do 3 g/dobę powodował wzrost siły mięśniowej aż u blisko 90% leczonych [68,69]. Istnieje ponadto badanie, w którym stwierdzono korzystny efekt dodania immunoglobulin dożylnych (ang.…”

“…W innym otwartym badaniu z MMF podawanym chorym z ILD w przebiegu różnych układowych chorób tkanki łącz-nej, do którego włączono także 5 pacjentów z ILD w przebiegu PM/DM, nie stwierdzono pogorszenia parametrów spirometrycznych przy dobrej tolerancji i bezpieczeństwie leku [70,71]. Znane są też opisy małych serii przypadków, w których obserwowano poprawę zmian skórnych po terapii MMF u pacjentów z opornością na inne leki immunosupresyjne [68].…”