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Lansang RP, Xiong G, Lansang P. Generalized granuloma annulare treated with mycophenolate mofetil. Int J Dermatol 2023; 62:e534-e535. [PMID: 37326299 DOI: 10.1111/ijd.16753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/10/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023]
Affiliation(s)
| | - Grace Xiong
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Perla Lansang
- Division of Dermatology, University of Toronto, Toronto, ON, Canada
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2
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Tremain AC, Wallace RP, Lorentz KM, Thornley TB, Antane JT, Raczy MR, Reda JW, Alpar AT, Slezak AJ, Watkins EA, Maulloo CD, Budina E, Solanki A, Nguyen M, Bischoff DJ, Harrington JL, Mishra R, Conley GP, Marlin R, Dereuddre-Bosquet N, Gallouët AS, LeGrand R, Wilson DS, Kontos S, Hubbell JA. Synthetically glycosylated antigens for the antigen-specific suppression of established immune responses. Nat Biomed Eng 2023; 7:1142-1155. [PMID: 37679570 DOI: 10.1038/s41551-023-01086-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/02/2023] [Indexed: 09/09/2023]
Abstract
Inducing antigen-specific tolerance during an established immune response typically requires non-specific immunosuppressive signalling molecules. Hence, standard treatments for autoimmunity trigger global immunosuppression. Here we show that established antigen-specific responses in effector T cells and memory T cells can be suppressed by a polymer glycosylated with N-acetylgalactosamine (pGal) and conjugated to the antigen via a self-immolative linker that allows for the dissociation of the antigen on endocytosis and its presentation in the immunoregulatory environment. We show that pGal-antigen therapy induces antigen-specific tolerance in a mouse model of experimental autoimmune encephalomyelitis (with programmed cell-death-1 and the co-inhibitory ligand CD276 driving the tolerogenic responses), as well as the suppression of antigen-specific responses to vaccination against a DNA-based simian immunodeficiency virus in non-human primates. Our findings show that pGal-antigen therapy invokes mechanisms of immune tolerance to resolve antigen-specific inflammatory T-cell responses and suggest that the therapy may be applicable across autoimmune diseases.
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Affiliation(s)
- Andrew C Tremain
- Committee on Immunology, University of Chicago, Chicago, IL, USA
| | - Rachel P Wallace
- Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL, USA
| | | | | | - Jennifer T Antane
- Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL, USA
| | - Michal R Raczy
- Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL, USA
| | - Joseph W Reda
- Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL, USA
| | - Aaron T Alpar
- Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL, USA
| | - Anna J Slezak
- Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL, USA
| | - Elyse A Watkins
- Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL, USA
| | - Chitavi D Maulloo
- Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL, USA
| | - Erica Budina
- Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL, USA
| | - Ani Solanki
- Animal Resources Center, University of Chicago, Chicago, IL, USA
| | - Mindy Nguyen
- Animal Resources Center, University of Chicago, Chicago, IL, USA
| | | | | | | | | | - Romain Marlin
- Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), Université Paris-Saclay, INSERM, CEA, Fontenay-aux-Roses, France
| | - Nathalie Dereuddre-Bosquet
- Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), Université Paris-Saclay, INSERM, CEA, Fontenay-aux-Roses, France
| | - Anne-Sophie Gallouët
- Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), Université Paris-Saclay, INSERM, CEA, Fontenay-aux-Roses, France
| | - Roger LeGrand
- Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), Université Paris-Saclay, INSERM, CEA, Fontenay-aux-Roses, France
| | - D Scott Wilson
- Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL, USA.
- Biomedical Engineering Department, Johns Hopkins University, Baltimore, MD, USA.
| | | | - Jeffrey A Hubbell
- Committee on Immunology, University of Chicago, Chicago, IL, USA.
- Pritzker School for Molecular Engineering, University of Chicago, Chicago, IL, USA.
- Committee on Cancer Biology, University of Chicago, Chicago, IL, USA.
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3
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Axler EN, Lipner SR. Nail lichen planus treatment safety. Expert Opin Drug Saf 2023; 22:1157-1168. [PMID: 38014463 DOI: 10.1080/14740338.2023.2288902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/24/2023] [Indexed: 11/29/2023]
Abstract
AREAS COVERED Topical therapies for nail lichen planus (clobetasol propionate, topical tacrolimus, bath-PUVA), intralesional treatment (triamcinolone), and systemic treatment (corticosteroids, retinoids, small molecule inhibitors (jak/stat inhibitors)), TNF-alpha inhibitors (etanercept), systemic immunomodulators (oral calcineurin inhibitors, mycophenolate mophetil), and antimalarials (chloroquine), each with unique safety profiles and considerations. Herein, we discuss common and uncommon adverse events, as well as utilization for special populations, including pregnant and pediatric patients.
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Affiliation(s)
- Eden N Axler
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Shari R Lipner
- Weill Cornell Medicine, Department of Dermatology, New York, NY, USA
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4
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Park BC, Jung S, Chen ST, Dewan AK, Johnson DB. Challenging Dermatologic Considerations Associated with Immune Checkpoint Inhibitors. Am J Clin Dermatol 2022; 23:707-717. [PMID: 35708849 DOI: 10.1007/s40257-022-00706-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/25/2022]
Abstract
Immune checkpoint inhibitors have emerged as a new paradigm in oncologic care for many malignancies. However, nonspecific immune activation has led to "collateral damage" in the form of immune-related adverse events, with skin being a commonly affected organ. Cutaneous immune-related adverse events include a wide spectrum of clinical presentations and challenging considerations, often necessitating dermatology referral to support diagnosis and management, particularly for atypical presentations or more severe, cutaneous immune-related adverse events that may require specialized dermatologic evaluations including biopsy and histopathology. Close collaborations between oncologists and dermatologists may optimize clinical decision making in the following challenging management settings: non-steroidal therapies for corticosteroid-refractory, cutaneous immune-related adverse events, immune checkpoint inhibitor rechallenge, balancing cutaneous immune-related adverse events and treatments, and immune checkpoint inhibitors in patients with pre-existing autoimmune disease, skin conditions, and organ transplants. These complex clinical decisions that often lack rigorous data should be made in close collaboration with dermatologists to minimize unnecessary morbidity and mortality. This article provides a review of approaches to challenging dermatologic considerations associated with immune checkpoint inhibitor therapies.
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Affiliation(s)
- Benjamin C Park
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Seungyeon Jung
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Steven T Chen
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Anna K Dewan
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, 2220 Pierce Avenue, 777 Preston Research Building, Nashville, TN, 3723, USA.
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5
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Mechanism and Management of Checkpoint Inhibitor-Related Toxicities in Genitourinary Cancers. Cancers (Basel) 2022; 14:cancers14102460. [PMID: 35626064 PMCID: PMC9139183 DOI: 10.3390/cancers14102460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 12/10/2022] Open
Abstract
The use of immune checkpoint inhibitors (ICIs) is rapidly increasing as more combinations and clinical indications are approved in the field of genitourinary malignancies. Most immunotherapeutic agents being approved are for the treatment of renal cell carcinoma and bladder cancer, which mainly involve PD-1/PD-L1 and CTLA-4 pathways. There is an ongoing need for recognizing and treating immunotherapy-related autoimmune adverse effects (irAEs). This review aims to critically appraise the recent literature on the mechanism, common patterns, and treatment recommendations of irAEs in genitourinary malignancies. We review the epidemiology of these adverse effects as well as general treatment strategies. The underlying mechanisms will also be discussed. Diagnostic considerations including differential diagnosis are also included in this review.
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6
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Hernández-Camba A, Arranz L, Vera I, Carpio D, Calafat M, Lucendo AJ, Taxonera C, Marín S, Garcia MJ, Marín GS, Rodríguez ES, Carbajo AY, De Castro ML, Iborra M, Martin-Cardona A, Rodríguez-Lago I, Busquets D, Bertoletti F, Ausín MS, Tardillo C, Malaves JH, Bujanda L, Castaño A, Domènech E, Ramos L. Real-world use of mycophenolate mofetil in inflammatory bowel disease: Results from the ENEIDA registry. Dig Liver Dis 2022; 54:635-641. [PMID: 34862115 DOI: 10.1016/j.dld.2021.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/22/2021] [Accepted: 10/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Studies to evaluate the use of mycophenolate mofetil (MMF) in inflammatory bowel disease (IBD) are limited after the appearance of biological treatments. AIMS Our primary objective was to evaluate the effectiveness and safety of MMF in IBD. METHODS IBD patients who had received MMF were retrieved from the ENEIDA registry. Clinical activity as per the Harvey-Bradshaw Index (HBI), partial Mayo score (pMS), physician global assessment (PGA) and C-reactive protein (CRP) were reviewed at baseline, at 3 and 6 months, and at final follow-up. Adverse events and causes of treatment discontinuation were documented. RESULTS A total of 83 patients were included (66 Crohn's disease, 17 ulcerative colitis), 90% of whom had previously received other immunosuppressants. In 61% of patients systemic steroids were used at initiation of MMF, and in 27.3% biological agents were co-administered with MMF. Overall clinical effectiveness was observed in 64.7% of the population. At the end of treatment, 45.6% and 19.1% of subjects showed remission and clinical response, respectively. MMF treatment was maintained for a median of 28.9 months (IQR: 20.4-37.5). CONCLUSION Our study suggests, in the largest cohort to date, that MMF may be an effective alternative to thiopurines and methotrexate in IBD.
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Affiliation(s)
- A Hernández-Camba
- Hospital Universitario Nuestra Señora de la Candelaria, Gastroenterology Dept., Santa Cruz de Tenerife, Spain.
| | - L Arranz
- Hospital Universitario Nuestra Señora de la Candelaria, Gastroenterology Dept., Santa Cruz de Tenerife, Spain
| | - I Vera
- Hospital Universitario Puerta de Hierro Majadahonda, Gastroenterology Dept., Madrid, Spain
| | - D Carpio
- Complexo Hospitalario Universitario de Pontevedra, Gastroenterology Dept., Pontevedra, Spain. Instituto de Investigación Sanitaria Galicia Sur
| | - M Calafat
- Hospital Universitario Germans Trias i Pujol, Gastroenterology Dept., Badalona, and CIBEREHD, Madrid, Spain
| | - A J Lucendo
- Hospital General de Tomelloso, Gastroenterology Dept., Tomelloso, and CIBEREHD, Spain
| | - C Taxonera
- Hospital Clínico Universitario San Carlos, Gastroenterology Dept., Madrid, Spain
| | - S Marín
- Hospital Reina Sofía, Gastroenterology Dept., Córdoba, Spain
| | - M J Garcia
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Gastroenterology Dept., Santander, Spain
| | - G Suris Marín
- Hospital Universitari de Bellvitge, Gastroenterology Dept., Barcelona, Spain
| | | | - A Y Carbajo
- Hospital Universitario Río Hortega, Gastroenterology Dept., Valladolid, Spain
| | - M L De Castro
- Complexo H. Universitario de Vigo, Gastroenterology Dept., Vigo, Spain
| | - M Iborra
- Hospital Universitari La Fe de Valencia and CIBEREHD, Gastroenterology Dept., Valencia, Spain
| | - A Martin-Cardona
- Hospital Universitari Mútua Terrassa and CIBEREHD, Gastroenterology Dept., Barcelona, Spain
| | - I Rodríguez-Lago
- Hospital General de Tomelloso, Gastroenterology Dept., Tomelloso, and CIBEREHD, Spain; Hospital de Galdakao, Gastroenterology Dept., and Biocruces Bizkaia Health Research Institute, Galdakao, Spain
| | - D Busquets
- Hospital Universitari Dr. Josep Trueta, Gastroenterology Dept., Girona, Spain
| | - F Bertoletti
- Hospital de la Santa Creu i Sant Pau, Gastroenterology Dept., Barcelona, Spain
| | - M Sierra Ausín
- Complejo Asistencial Universitario de León, Gastroenterology Dept., León, Spain
| | - C Tardillo
- Hospital Universitario Nuestra Señora de la Candelaria, Gastroenterology Dept., Santa Cruz de Tenerife, Spain
| | - J Huguet Malaves
- Hospital General Universitario de Valencia, Gastroenterology Dept., Valencia, Spain
| | - L Bujanda
- Hospital Universitario de Donostia - Instituto Biodonostia - Universidad del País Vasco UPV/EHU- and CIBEREHD, Gastroenterology Dept., Donostia, Spain
| | - A Castaño
- Hospital Universitario Central de Asturias, Gastroenterology Dept., Oviedo, Spain
| | - E Domènech
- Hospital Universitario Germans Trias i Pujol, Gastroenterology Dept., Badalona, and CIBEREHD, Madrid, Spain
| | - L Ramos
- Hospital Universitario de Canarias, Gastroenterology Dept., La Laguna, Spain
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7
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Wang Y, Jorizzo J. Analysis of utilization, cost and prescription trends of mycophenolate mofetil and methotrexate among medicare patients. J DERMATOL TREAT 2021; 33:1798-1799. [PMID: 33554688 DOI: 10.1080/09546634.2021.1886229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Yu Wang
- SUNY Stonybrook Medical School, Stonybrook, NY, USA
| | - Joseph Jorizzo
- Department of Dermatology, Wake Forest University, Winston-Salem, NC, USA
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8
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Yun JSW, Yap T, Martyres R, Kern JS, Varigos G, Scardamaglia L. The association of mycophenolate mofetil and human herpes virus infection. J DERMATOL TREAT 2019; 31:46-55. [DOI: 10.1080/09546634.2019.1572864] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Jenny Sung Won Yun
- Departments of Dermatology, Royal Melbourne Hospital, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia
| | - Tami Yap
- Departments of Dermatology, Royal Melbourne Hospital, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia
- Melbourne Dental School, University of Melbourne, Victoria, Australia
| | - Raymond Martyres
- Departments of Dermatology, Royal Melbourne Hospital, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia
| | - Johannes S. Kern
- Departments of Dermatology, Royal Melbourne Hospital, Victoria, Australia
| | - George Varigos
- Departments of Dermatology, Royal Melbourne Hospital, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia
| | - Laura Scardamaglia
- Departments of Dermatology, Royal Melbourne Hospital, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia
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9
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Didona D, Maglie R, Eming R, Hertl M. Pemphigus: Current and Future Therapeutic Strategies. Front Immunol 2019; 10:1418. [PMID: 31293582 PMCID: PMC6603181 DOI: 10.3389/fimmu.2019.01418] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/05/2019] [Indexed: 12/16/2022] Open
Abstract
Pemphigus encompasses a heterogeneous group of autoimmune blistering diseases, which affect both mucous membranes and the skin. The disease usually runs a chronic-relapsing course, with a potentially devastating impact on the patients' quality of life. Pemphigus pathogenesis is related to IgG autoantibodies targeting various adhesion molecules in the epidermis, including desmoglein (Dsg) 1 and 3, major components of desmosomes. The pathogenic relevance of such autoantibodies has been largely demonstrated experimentally. IgG autoantibody binding to Dsg results in loss of epidermal keratinocyte adhesion, a phenomenon referred to as acantholysis. This in turn causes intra-epidermal blistering and the clinical appearance of flaccid blisters and erosions at involved sites. Since the advent of glucocorticoids, the overall prognosis of pemphigus has largely improved. However, mortality persists elevated, since long-term use of high dose corticosteroids and adjuvant steroid-sparing immunosuppressants portend a high risk of serious adverse events, especially infections. Recently, rituximab, a chimeric anti CD20 monoclonal antibody which induces B-cell depletion, has been shown to improve patients' survival, as early rituximab use results in higher disease remission rates, long term clinical response and faster prednisone tapering compared to conventional immunosuppressive therapies, leading to its approval as a first line therapy in pemphigus. Other anti B-cell therapies targeting B-cell receptor or downstream molecules are currently tried in clinical studies. More intriguingly, a preliminary study in a preclinical mouse model of pemphigus has shown promise regarding future therapeutic application of Chimeric Autoantibody Receptor T-cells engineered using Dsg domains to selectively target autoreactive B-cells. Conversely, previous studies from our group have demonstrated that B-cell depletion in pemphigus resulted in secondary impairment of T-cell function; this may account for the observed long-term remission following B-cell recovery in rituximab treated patients. Likewise, our data support the critical role of Dsg-specific T-cell clones in orchestrating the inflammatory response and B-cell activation in pemphigus. Monitoring autoreactive T-cells in patients may indeed provide further information on the role of these cells, and would be the starting point for designating therapies aimed at restoring the lost immune tolerance against Dsg. The present review focuses on current advances, unmet challenges and future perspectives of pemphigus management.
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Affiliation(s)
- Dario Didona
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Roberto Maglie
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany.,Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy.,Section of Dermatology, Departement of Health Sciences, University of Florence, Florence, Italy
| | - Rüdiger Eming
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
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Concurrence of Bullous Pemphigoid and Psoriasis: A Case Report. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2019. [DOI: 10.2478/sjdv-2018-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Bullous pemphigoid (BP) and psoriasis are chronic recurrent inflammatory skin diseases. The pathogenesis of concurrence of BP with psoriasis is still unknown. A 39-year-old male with a five-year history of chronic plaque psoriasis developed itchy large tense bullae on the trunk and upper extremities after he had been receiving narrow band ultraviolet B (NBUVB) therapy over five months. Skin biopsy from bulla on the trunk showed typical histological features of BP. Direct immunofluorescent staining showed deposit of immunoglobulin G and C3 in the basement membrane zone (BMZ) which supported the diagnosis of BP. It has been postulated that the autoimmune process responsible for BP lesions might be induced by ultraviolet light therapy and/or the inflammatory processes that occur in psoriasis.
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11
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Thompson JA, Schneider BJ, Brahmer J, Andrews S, Armand P, Bhatia S, Budde LE, Costa L, Davies M, Dunnington D, Ernstoff MS, Frigault M, Hoffner B, Hoimes CJ, Lacouture M, Locke F, Lunning M, Mohindra NA, Naidoo J, Olszanski AJ, Oluwole O, Patel SP, Reddy S, Ryder M, Santomasso B, Shofer S, Sosman JA, Wahidi M, Wang Y, Johnson-Chilla A, Scavone JL. Management of Immunotherapy-Related Toxicities, Version 1.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 17:255-289. [DOI: 10.6004/jnccn.2019.0013] [Citation(s) in RCA: 288] [Impact Index Per Article: 57.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aim of the NCCN Guidelines for Management of Immunotherapy-Related Toxicities is to provide guidance on the management of immune-related adverse events resulting from cancer immunotherapy. The NCCN Management of Immunotherapy-Related Toxicities Panel is an interdisciplinary group of representatives from NCCN Member Institutions and ASCO, consisting of medical and hematologic oncologists with expertise in a wide array of disease sites, and experts from the fields of dermatology, gastroenterology, neuro-oncology, nephrology, emergency medicine, cardiology, oncology nursing, and patient advocacy. Several panel representatives are members of the Society for Immunotherapy of Cancer (SITC). The initial version of the NCCN Guidelines was designed in general alignment with recommendations published by ASCO and SITC. The content featured in this issue is an excerpt of the recommendations for managing toxicity related to immune checkpoint blockade and a review of existing evidence. For the full version of the NCCN Guidelines, including recommendations for managing toxicities related to chimeric antigen receptor T-cell therapy, visitNCCN.org.
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Affiliation(s)
- John A. Thompson
- 1Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Julie Brahmer
- 3The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | - Shailender Bhatia
- 1Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Luciano Costa
- 7University of Alabama at Birmingham Comprehensive Cancer Center
| | | | | | | | | | | | - Christopher J. Hoimes
- 13Case Comprehensive Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | - Nisha A. Mohindra
- 16Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Jarushka Naidoo
- 3The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | | | | | - Jeffrey A. Sosman
- 16Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Yinghong Wang
- 23The University of Texas MD Anderson Cancer Center; and
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12
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Dridi I, Chaabane A, Ben-Cherif W, Aouam K, Haouas Z, Ben-Attia M, Boughattas NA. Circadian variation in intestine toxicity of Mycophenolate mofetil in rats: an experimental and histopathologic study. BIOL RHYTHM RES 2018. [DOI: 10.1080/09291016.2018.1533732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ichrak Dridi
- Laboratory of Pharmacology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Amel Chaabane
- Laboratory of Pharmacology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Wafa Ben-Cherif
- Laboratory of Pharmacology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Karim Aouam
- Laboratory of Pharmacology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Zohra Haouas
- Laboratory of Histology Embryology and Cytogenetic, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Mossadok Ben-Attia
- Laboratory of Biomonitoring of the Environment, Faculty of Sciences of Bizerte, Carthage University, Zarzouna, Tunisia
| | - Naceur A. Boughattas
- Laboratory of Pharmacology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Abstract
Pemphigus vulgaris (PV) is a life-threatening disease belonging to the pemphigus group of autoimmune intra-epidermal bullous diseases of the skin and mucosae. The therapeutic management of PV remains challenging and, in some cases, conventional therapy is not adequate to induce clinical remission. The cornerstone of PV treatment remains systemic corticosteroids. Although very effective, long-term corticosteroid administration is characterized by substantial adverse effects. Corticosteroid-sparing adjuvant therapies have been employed in the treatment of PV, aiming to reduce the necessary cumulative dose of corticosteroids. Specifically, immunosuppressive agents such as azathioprine and mycophenolate mofetil are widely used in PV. More recently, high-dose intravenous immunoglobulins, immunoadsorption, and rituximab have been established as additional successful therapeutic options. This review covers both conventional and emerging therapies in PV. In addition, it sheds light on potential future treatment strategies for this disease.
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Affiliation(s)
- Khalaf Kridin
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
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14
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Harman K, Brown D, Exton L, Groves R, Hampton P, Mohd Mustapa M, Setterfield J, Yesudian P, McHenry P, Gibbon K, Buckley D, Leslie T, Mallon E, Wakelin S, Ungureanu S, Hunasehally R, Cork M, Johnston G, Natkunarajah J, Worsnop F, Chiang N, Duarte Williamson C, Donnelly J, Saunders C, Brain A. British Association of Dermatologists’ guidelines for the management of pemphigus vulgaris 2017. Br J Dermatol 2017; 177:1170-1201. [DOI: 10.1111/bjd.15930] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2017] [Indexed: 12/11/2022]
Affiliation(s)
- K.E. Harman
- University Hospitals Leicester Leicester Royal Infirmary Infirmary Square Leicester LE1 5WW U.K
| | - D. Brown
- St John's Institute of Dermatology Guy's and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital Westminster Bridge Road London SE1 7EH U.K
| | - L.S. Exton
- British Association of Dermatologists Willan House, 4 Fitzroy Square London W1T 5HQ U.K
| | - R.W. Groves
- St. John's Institute of Dermatology King's College London Guy's Campus, Great Maze Pond London SE1 9RT U.K
| | - P.J. Hampton
- Royal Victoria Infirmary Queen Victoria Road Newcastle upon Tyne Tyne and Wear NE1 4LP U.K
| | - M.F. Mohd Mustapa
- British Association of Dermatologists Willan House, 4 Fitzroy Square London W1T 5HQ U.K
| | - J.F. Setterfield
- St. John's Institute of Dermatology King's College London Guy's Campus, Great Maze Pond London SE1 9RT U.K
- Mucosal & Salivary Biology Division King's College London Dental Institute Guy's Campus, Great Maze Pond London SE1 9RT U.K
| | - P.D. Yesudian
- Wrexham Maelor Hospital Croesnewydd Road Wrexham LL13 7TD U.K
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Macaluso FS, Maida M, Renna S, Orlando E, Affronti M, Sapienza C, Dimarco M, Orlando R, Rizzuto G, Cottone M, Orlando A. Mycophenolate mofetil is a valid option in patients with inflammatory bowel disease resistant to TNF-α inhibitors and conventional immunosuppressants. Dig Liver Dis 2017; 49:157-162. [PMID: 27876682 DOI: 10.1016/j.dld.2016.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/02/2016] [Accepted: 10/03/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Few studies investigated the role of mycophenolate mofetil in inflammatory bowel disease, and none of them had specifically focused on patients with previous multiple intolerances and/or nonresponses to conventional immunosuppressants and biologics. AIMS To evaluate clinical benefit and tolerability profile of mycophenolate mofetil in patients with inflammatory bowel disease and limited treatment options. METHODS All consecutive patients with previous multiple intolerances and/or nonresponses to immunosuppressants and biologics who started an off-label treatment with mycophenolate mofetil from January 2014 to February 2016 were entered in a prospectively maintained database. RESULTS Twenty-four patients were included. Four weeks after initiation of mycophenolate mofetil therapy, a steroid-free remission was achieved in 4 patients (16.7%), while a clinical response in 13 (54.1%). At the end of follow-up, 12 patients (50.0%) remained on mycophenolate mofetil. Six achieved and maintained steroid-free remission throughout the study period (25.0%), and a further 6 patients (25.0%) achieved a clinical response with complete discontinuation of steroids. Twelve patients (50.0%) were considered as treatment failure, and five of them underwent surgery. CONCLUSIONS This is the first experience reporting a clinical benefit and tolerability of mycophenolate mofetil in patients with inflammatory bowel disease and multiple previous failures to other immunosuppressants and/or biologics.
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Affiliation(s)
- Fabio Salvatore Macaluso
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy.
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Sara Renna
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - Emanuele Orlando
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - Marco Affronti
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - Chiara Sapienza
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - Mariangela Dimarco
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - Rosalba Orlando
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - Giulia Rizzuto
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - Mario Cottone
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
| | - Ambrogio Orlando
- Di.Bi.M.I.S., Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, University of Palermo, Italy
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Metastatic Crohn's Disease: An Approach to an Uncommon but Important Cutaneous Disorder. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8192150. [PMID: 28127561 PMCID: PMC5239966 DOI: 10.1155/2017/8192150] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 12/07/2016] [Indexed: 01/06/2023]
Abstract
Objective. To provide physicians with a clinical approach to metastatic Crohn's disease (MCD). Main Message. Metastatic Crohn's disease, defined as skin lesions present in areas noncontiguous with the gastrointestinal tract, is the rarest cutaneous manifestation of Crohn's disease. MCD lesions vary in morphology and can arise anywhere on the skin. MCD presents equally in both sexes and across age groups. Cutaneous findings may precede, develop concurrently with, or follow gastrointestinal involvement. A detailed history and thorough physical examination including a full-skin exam may help to exclude other dermatoses, as MCD can mimic other common disorders. A biopsy is required for a definitive diagnosis. Treatment options for MCD remain underwhelming due to the lack of randomized control studies and varying responses of reported therapeutic methods. Topical, intralesional, and systemic corticosteroids, antibiotics, traditional immunosuppressants, and surgery have shown mixed results. Recently, biologics have shown promise, even with refractory cases of MCD. Conclusion. MCD is an important cutaneous manifestation of this inflammatory disorder. Although a rare entity, early recognition can provide opportunity for successful therapeutic intervention.
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Abstract
Mycophenolate mofetil (MMF) is an immunosuppressive drug the efficiency of which has been established in renal transplantation. Recent studies suggest that it may also be effective in the treatment of variant skin diseases especially if the skin lesions are triggered by lymphocytes. Studies have shown efficacy in autoimmune bullous dermatoses, atopic dermatitis and psoriasis. However, there are no placebo-controlled trials that support the use of MMF as first line therapy in these skin diseases.
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Affiliation(s)
- M Hartmann
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - A Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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Abstract
Mycophenolate mofetil (MMF) is an immunosuppressive drug the efficiency of which has been established in renal transplantation. Recent studies suggest that it may also be effective in the treatment of variant skin diseases especially if the skin lesions are triggered by lymphocytes. Studies have shown efficacy in autoimmune bullous dermatoses, atopic dermatitis and psoriasis. However, there are no placebo-controlled trials that support the use of MMF as first line therapy in these skin diseases.
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Affiliation(s)
- M Hartmann
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany.
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Zhou Y, Rosenthal D, Dutz J, Ho V. Mycophenolate Mofetil (CellCept®) for Psoriasis: A Two-Center, Prospective, Open-Label Clinical Trial. J Cutan Med Surg 2016. [DOI: 10.1177/120347540300700302] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Mycophenolate mofetil (MMF) is an immune suppressant that selectively inhibits activated lymphocytes. Its usefulness in treating psoriasis has not been systematically investigated. Objective: To evaluate efficacy and safety of MMF as a monotherapy for psoriasis. Methods: This is a two-center, prospective, open-label clinical trial. Results: Twenty-three patients with moderate to severe psoriasis [mean psoriasis area and severity index (PASI) of 21.7] were treated with MMF 2–3 g/day for 12 weeks. Eighteen patients completed the study. The PASI was reduced by 24% ( p < 0.001) at 6 weeks, and by 47% ( p < 0.001) at 12 weeks. At the end of the treatment phase, 77% of the patients had significant reduction of PASI while 22% did not respond. The treatment was well tolerated. Five patients experienced mild nausea. One patient each had periorbital edema and pruritus. One patient had transient leukopenia. Conclusion: In this noncontrolled trial, the majority of patients with moderate to severe psoriasis responded to mycophenolate mofetil monotherapy with few adverse events. A randomized, controlled trial should be considered to confirm the usefulness of MMF as a monotherapy for psoriasis.
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Affiliation(s)
- Youwen Zhou
- Division of Dermatology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jan Dutz
- Division of Dermatology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vincent Ho
- Division of Dermatology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Mycophenolate Mofetil Modulates Differentiation of Th1/Th2 and the Secretion of Cytokines in an Active Crohn's Disease Mouse Model. Int J Mol Sci 2015; 16:26654-66. [PMID: 26561804 PMCID: PMC4661844 DOI: 10.3390/ijms161125985] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 10/08/2015] [Accepted: 10/23/2015] [Indexed: 01/06/2023] Open
Abstract
Mycophenolate mofetil (MMF) is an alternative immunosuppressive agent that has been reported to be effective and well tolerated for the treatment of refractory inflammatory bowel disease (IBD). The aim of this study was to investigate the therapeutic effect of MMF on intestinal injury and tissue inflammation, which were caused by Crohn’s disease (CD). Here, trinitrobenzene sulfonic acid-relapsing (TNBS) colitis was induced in mice; then, we measured the differentiation of Th1/Th2 cells in mouse splenocytes by flow cytometry and the secretion of cytokines in mice with TNBS-induced colitis by real-time polymerase chain reaction and/or enzyme-linked immunosorbent assay (RT-PCR/ELISA). The results show that MMF significantly inhibited mRNA expression of pro-inflammatory cytokines IFN-γ, TNF-α, IL-12, IL-6, and IL-1β in mice with TNBS-induced colitis; however, MMF did not inhibit the expression of IL-10 mRNA. Additionally, ELISA showed that the serum levels of IFN-γ, TNF-α, IL-12, IL-6, and IL-1β were down-regulated in a TNBS model of colitis. Flow cytometric analysis showed MMF markedly reduced the percentages of Th1 and Th2 splenocytes in the CD mouse model. Mycophenolic acid (MPA) also significantly decreased the percentages of splenic Th1 and Th2 cells in vitro. Furthermore, MMF treatment not only significantly ameliorated diarrhea, and loss of body weight but also abrogated the histopathologic severity and inflammatory response of inflammatory colitis, and increased the survival rate of TNBS-induced colitic mice. These results suggest that treatment with MMF may improve experimental colitis and induce inflammatory response remission of CD by down-regulation of pro-inflammatory cytokines via modulation of the differentiation of Th1/Th2 cells.
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Moustafa FA, Sandoval LF, Jorizzo JL, Huang WW. Systemic treatment of papular dermatitis: A retrospective study. J DERMATOL TREAT 2015; 26:431-4. [PMID: 25672516 DOI: 10.3109/09546634.2014.1002443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Papular dermatitis is an intensely pruritic eruption that is often refractory to conventional therapy. AIM The aim of this study was to evaluate the efficacy of different non-steroidal systemic therapies for long-term control of disease in patients with papular dermatitis. METHODS This was a single center, retrospective study involving a chart review of patients with a diagnosis of papular dermatitis who were prescribed systemic therapy between 1 January 2002 and 31 December 2012. RESULTS Fourteen patients were identified that were treated with a systemic agent. Median duration of treatment was 25 months. Methotrexate was used first line in 12 patients, with control of disease achieved in eight patients with a dose between 2.5 and 10 mg weekly. Azathioprine and mycophenolate mofetil also provided control of disease when used as first-line therapy in the remaining two patients. While azathiopurine was effective in patients who failed methotrexate, gastrointestinal side effects limited its use long term. CONCLUSIONS Low dose weekly methotrexate, as well as, azathioprine and mycophenolate mofetil are long-term treatment options for patients with papular dermatitis refractory to other therapies.
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Affiliation(s)
- Farah A Moustafa
- a Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Laura F Sandoval
- a Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Joseph L Jorizzo
- a Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - William W Huang
- a Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
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Kawashita MY, Tsai K, Aoki V, Santi CG, Maruta CW, Rivitti E. Mycophenolate Mofetil as an Adjuvant Therapy for Classic and Endemic Pemphigus Foliaceus. J Dermatol 2014; 32:574-80. [PMID: 16335874 DOI: 10.1111/j.1346-8138.2005.tb00801.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pemphigus foliaceus is an autoimmune cutaneous disease with subcorneal acantholysis and pathogenic IgG4 autoantibodies directed against desmoglein 1. We present our experience with mycophenolate mofetil (MMF) in the treatment of one case of endemic pemphigus foliaceus (fogo selvagem) and two cases of the classic form. All patients had severe, refractory disease and developed marked adverse effects due to long-term corticosteroid therapy. MMF proved to be an effective corticosteroid-sparing agent at doses varying from 35 to 45 mg/kg/d. It was well tolerated, and we found no significant adverse effects from this drug.
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Kurtzman DJB, Jones T, Lian F, Peng LS. Metastatic Crohn's disease: a review and approach to therapy. J Am Acad Dermatol 2014; 71:804-13. [PMID: 24888520 DOI: 10.1016/j.jaad.2014.04.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/31/2014] [Accepted: 04/01/2014] [Indexed: 12/18/2022]
Abstract
Metastatic Crohn's disease (CD) is a rare cutaneous manifestation of CD that was first described nearly 50 years ago. Many subsequent reports have defined its most common clinical and histopathologic features. The pathogenesis underlying metastatic CD is unknown but various hypotheses exist. An established standard therapy is lacking. Owing to its rarity and nonspecific clinical presentation along with the diversity of inflammatory skin disorders that often complicate CD, the diagnosis of metastatic CD may be overlooked. This report highlights the salient features of this disorder to facilitate recognition and management of this rare dermatosis.
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Affiliation(s)
- Drew J B Kurtzman
- Division of Dermatology, University of Arizona College of Medicine, Tucson, Arizona.
| | - Trevor Jones
- Division of Dermatology, University of Arizona College of Medicine, Tucson, Arizona
| | - Fangru Lian
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona
| | - Lisan S Peng
- Division of Dermatology, University of Arizona College of Medicine, Tucson, Arizona
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Doukaki S, Platamone A, Alaimo R, Bongiorno MR. Mycophenolate mofetil and enteric-coated mycophenolate sodium in the treatment of pemphigus vulgaris and pemphigus foliaceus. J DERMATOL TREAT 2014; 26:67-72. [PMID: 24521072 DOI: 10.3109/09546634.2014.880395] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED What is known and objective: Pemphigus is a severe, potentially life-threatening autoimmune blistering disease. The use of corticosteroids has dramatically improved the prognosis and changed its course. However, current morbidity of pemphigus is largely iatrogenic, caused by side effects of the long-term, high-dose corticosteroid therapy that is necessary to sustain disease control. In order to minimize side effects, a range of corticosteroid-sparing immunosuppressive agents have been introduced, including mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS). A systematic review was performed to evaluate the effectiveness of MMF and EC-MPS in the treatment of pemphigus vulgaris and pemphigus foliaceus. METHODS A retrospective literature search was conducted through multiple electronic databases (PubMed, Medline, The Cochrane database of systematic reviews) for reports on the use of mycophenolic acid (MPA) in the treatment of pemphigus vulgaris and pemphigus foliaceus. RESULTS Sixteen studies with a total of 239 patients have evaluated the treatment of pemphigus vulgaris and pemphigus foliac;eus with MPA. The majority of patients had refractory disease treated with corticosteroids as monotherapy or associated to adjuvant agents. DISCUSSION The results of this review suggest that MPA, as MMF or EC-MPS, may be a promising adjuvant or alternative therapy for the treatment of pemphigus vulgaris and pemphigus foliaceus. It appears safe, at least in the medium term and its adverse events seem to be dose dependent. WHAT IS NEW AND CONCLUSION The use of mycophenolate is first-line adjuvant therapy in the treatment of pemphigus vulgaris and pemphigus foliaceus.
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Affiliation(s)
- Spyridoula Doukaki
- Department of Dermatology, University of Palermo , Palermo, Sicily , Italy
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Li J, Chong AH, Green J, Kelly R, Baker C. Mycophenolate use in dermatology: A clinical audit. Australas J Dermatol 2013; 54:296-302. [DOI: 10.1111/ajd.12042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 02/04/2013] [Indexed: 01/27/2023]
Affiliation(s)
- Jane Li
- Department of Dermatology; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
| | - Alvin H Chong
- Department of Dermatology; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
- Skin and Cancer Foundation Inc.; Melbourne Victoria Australia
| | - Jack Green
- Department of Dermatology; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
- Skin and Cancer Foundation Inc.; Melbourne Victoria Australia
| | - Robert Kelly
- Department of Dermatology; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
| | - Christopher Baker
- Department of Dermatology; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
- Skin and Cancer Foundation Inc.; Melbourne Victoria Australia
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Fallah Arani S, Waalboer Spuij R, Nijsten T, Neumann HAM, Thio B. Enteric-coated mycophenolate sodium in psoriasis vulgaris: an open pilot study. J DERMATOL TREAT 2013; 25:46-9. [PMID: 22998609 DOI: 10.3109/09546634.2012.723124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Mycophenolate mofetil is a well-known immunosuppressive agent in transplantation medicine. The efficacy of enteric-coated mycophenolate sodium (EC-MPS) was confirmed in other inflammatory skin diseases, including atopic dermatitis and SCLE. OBJECTIVE To investigate the efficacy and the tolerability/short-term safety of EC-MPS in patients with moderate to severe chronic plaque psoriasis. PATIENTS AND METHODS An open-label pilot study in which 20 patients with a PASI >10 received EC-MPS 720 mg twice daily for 6 weeks followed by 360 mg twice daily for another 6 weeks. Patients who completed 12 weeks of treatment were followed-up for an additional 12 weeks. Treatment outcomes were assessed with PASI50% and PASI75%. RESULTS Eighteen men and two women (mean age 46 years) entered the study. Sixty-five percent (13/20) finished the treatment period. By week 6, no patient achieved PASI 75% and 8/20 patients achieved a PASI 50%. Compared to week 6, 4/13 showed a deterioration of their psoriasis at week 12. Twenty-five percent (2/8) achieved a PASI 75% in week 24. The most-reported adverse events were itching (30%), diarrhea (10%), and a reversible elevation of the triglycerides level. CONCLUSION EC-MPS does not seem effective as monotherapy for moderate to severe psoriasis, but might be used at a dosage of 1440 mg daily in well-selected patients with treatment-resistant psoriasis.
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Affiliation(s)
- Shiva Fallah Arani
- Department of Dermatology & Venereology, Erasmus MC , Rotterdam , The Netherlands
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SAKANOUE M, KAWAI K, KANEKURA T. Bullous pemphigoid associated with type 1 diabetes mellitus responsive to mycophenolate mofetil. J Dermatol 2012; 39:884-5. [DOI: 10.1111/j.1346-8138.2011.01439.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gammon B, Hansen C, Costner MI. Efficacy of mycophenolate mofetil in antimalarial-resistant cutaneous lupus erythematosus. J Am Acad Dermatol 2011; 65:717-721.e2. [PMID: 21641078 DOI: 10.1016/j.jaad.2010.08.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 08/04/2010] [Accepted: 08/08/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Mycophenolate mofetil (MMF) is an immunomodulatory drug shown to be effective in the treatment of systemic lupus erythematosus. Several anecdotal reports have suggested that MMF may be efficacious in the treatment of cutaneous lupus erythematosus (CLE). OBJECTIVES Our objective was to summarize and report our experience with the use of MMF in patients with CLE recalcitrant to antimalarial therapy. METHODS We retrospectively analyzed our open-label observations of 24 patients with CLE refractory to antimalarial therapy. The records of all patients visiting the Rheumatic Skin Disease Clinic at the University of Texas Southwestern Medical Center at Dallas from January 1, 2001, to July 1, 2006, were reviewed. RESULTS MMF was tolerated well and, in conjunction with other therapies, was highly effective in the treatment of antimalarial-resistant CLE. With the addition of MMF to the existing regimen, a majority of patients achieved full control of disease signs and symptoms. All patients experienced some degree of improvement. LIMITATIONS This is an open-label retrospective review. Severity of disease was assessed by qualitative assessment of the clinician. MMF was not used as monotherapy. CONCLUSIONS Our results indicate that MMF, used as an additional agent in conjunction with standard therapy, is both well tolerated and efficacious in the treatment of refractory CLE. Despite the obvious limitations of the study, we believe this represents further evidence that MMF should be considered early in the treatment of patients refractory to antimalarial therapy.
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Affiliation(s)
- Bryan Gammon
- Department of Dermatology, Northwestern University, Chicago, Illinois.
| | - Christopher Hansen
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Melissa I Costner
- Department of Dermatology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
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SHAHSHAHANI MM, AZIZAHARI S, SOORI T, MANAVI S, BALIGHI K, DANESHPAZHOOH M, DAVATCHI CS, ESMAILI N. Hepatotoxicity and liver enzyme alteration in patients with immunobullous diseases receiving immunosuppressive therapy. J Dermatol 2011; 38:1153-7. [DOI: 10.1111/j.1346-8138.2011.01278.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Doukaki S, Pistone G, Aricò M, Bongiorno MR. Pharmacokinetic evaluation of mycophenolate mofetil for pemphigus. Expert Opin Drug Metab Toxicol 2011; 7:237-44. [PMID: 21192770 DOI: 10.1517/17425255.2011.542149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Pemphigus is an autoimmune blistering disease of the skin and mucous membranes characterized by the development of autoantibodies against the desmosomal proteins, desmoglein-1 and -3. Before the advent of corticosteroids, therapy was almost fatal. The introduction of high-dose corticosteroid therapy has reduced mortality rates to ∼ 10%, but long-term use of steroids can lead to side effects, many of which are severe and associated with significant morbidity. Thus, the major goal of pemphigus therapy has been to reduce the patient's cumulative exposure to systemic corticosteroids. Over the last 2 decades, a range of corticosteroid-sparing immunosuppressive agents have been described, but these therapies are not without potentially serious complications. Despite the range of treatment options, a proportion of patients do not achieve remission, while others show an initial treatment response but remain poorly controlled. The recent availability of mycophenolate mofetil (MMF), originally developed for preventing allograft rejection, appears to be effective in autoimmune blistering diseases in combination with systemic corticosteroid or as a monotherapy. AREAS COVERED This review aims to provide an extensive overview of the literature on the clinical pharmacokinetics of MMF in pemphigus treatment and a brief summary of current pharmacodynamic information. After completing this learning activity, readers should be able to summarize the pharmacology of MMF as an immunosuppressant; recognize its potential role in the treatment of pemphigus, including general dosing guidelines and laboratory monitoring schedules, use in patient populations and potential adverse effects; and identify future considerations and developing areas of research regarding the use of mycophenolic acid in the treatment of autoimmune blistering diseases. EXPERT OPINION Current morbidity of pemphigus is largely iatrogenic, caused by side effects of the long-term, high-dose corticosteroid therapy that is necessary to sustain disease control. MMF demonstrates complex pharmacokinetics and displays large between-subject pharmacokinetic variability. Experience with MMF has demonstrated long-term safety and tolerability in the treatment of pemphigus.
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Affiliation(s)
- Spyridoula Doukaki
- University of Palermo, Department of Dermatology, Via del Vespro 131, 90127, Palermo, Italy
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Abstract
The diagnosis and management of the following non-infectious vulvar ulcers are reviewed: vulvar aphthae in adult and pediatric patients, aphthae associated with Behçet's disease, vulvar ulcers resulting from Crohn's disease, and vulvar ulcers associated with human immunodeficiency virus infection. There are many resources providing excellent reviews of infectious ulcers; therefore this topic will not be covered here.
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Bakulev AL, Bakulev AL. Tacrolimus: 10 years of successful clinical application. VESTNIK DERMATOLOGII I VENEROLOGII 2010. [DOI: 10.25208/vdv775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Tacrolimus (FK506) is the first drug from the new class of drugs - calcineurin inhibitors. It has a great potential and can change
the current approaches to treatment of different dermatoses. Topical forms of Tacrolimus are activated due to the effect on T-lymphocyte
signal transduction, and they also inhibit gene transcription. As a result, the T-cell response to antigens is alleviated.
Percutaneous absorption of Tacrolimus in affection foci is higher than in healthy skin. Due to this a smaller amount of the drug
is absorbed by the skin as long as the skin is healed. Systemic absorption of Tacrolimus is low in the course of treatment. The
maximum clinical experience has been gained in the field of applying Tacrolimus for treatment of atopic dermatitis. In a number of
clinical studies, 0.03-0.3% Tacrolimus ointment efficiently reduced the severity of symptoms and course of atopic dermatitis in
adults and children. Moreover, topical treatment with Tacrolimus did not involve any substantial toxic effects. The patients most often
complained of local irritations in the area where the ointment was applied, which were transient by nature and did not demand
the drug withdrawal. Today Tacrolimus is a valuable and safer alternative to glucocorticosteroids for treatment of atopic dermatitis.
It can also be used for treating other dermatoses, which demands additional all-round examination.
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Treating Pemphigus Vulgaris with Prednisone and Mycophenolate Mofetil: A Multicenter, Randomized, Placebo-Controlled Trial. J Invest Dermatol 2010; 130:2041-8. [PMID: 20410913 DOI: 10.1038/jid.2010.91] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lo Schiavo A, Puca RV, Ruocco V, Ruocco E. Adjuvant drugs in autoimmune bullous diseases, efficacy versus safety: Facts and controversies. Clin Dermatol 2010; 28:337-43. [DOI: 10.1016/j.clindermatol.2009.06.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
Originally used to treat psoriasis nearly three decades ago, mycophenolic acid, reformulated as mycophenolate mofetil (MMF), has been rediscovered by the world of dermatology. As a relatively well-tolerated immunosuppressive used in organ transplant recipients, MMF has recently been reported to show promise for several dermatologic conditions, including psoriasis, pemphigus vulgaris, pyoderma gangrenosum, bullous lichen planus, and even connective tissue diseases such as lupus erythematosus and dermatomyositis. Although not intended to be exhaustive, this review discusses MMF with regard to its basic pharmacology, its side effects, and its reported efficacy in a variety of dermatologic indications. Relevant literature was retrieved by a Medline search combining the terms "mycophenolate" or "mycophenolic acid" and "skin" or "skin disease" or a number of specific conditions ("psoriasis", "dermatitis", "eczema", "pemphigoid", "pemphigus", "vasculitis", "pyoderma gangrenosum", "Crohn's disease", "graft-versus-host disease", "lichen planus"). As MMF has only been recently re-introduced for dermatologic application, the nature of much of the literature is admittedly that of case reports or case series. Nevertheless, the results are sufficiently promising to warrant further larger, control studies.
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Affiliation(s)
- V Liu
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital Dermatopathology Unit, 55 Fruit Street, Boston, MA 02114, USA.
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Marzano AV, Dassoni F, Caputo R. Treatment of refractory blistering autoimmune diseases with mycophenolic acid. J DERMATOL TREAT 2009; 17:370-6. [PMID: 17853312 DOI: 10.1080/09546630600964999] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Immunosuppressive drugs are used as steroid-sparing agents in the management of blistering autoimmune diseases. Mycophenolic acid (MPA) is a relatively new adjuvant drug that selectively inhibits T and B lymphocyte proliferation by suppressing de novo purine synthesis. OBJECTIVE To evaluate the efficacy of MPA in refractory blistering autoimmune diseases and the safety profile of a recent formulation, enteric-coated mycophenolate sodium (EC-MPS), in comparison with mycophenolate mofetil (MMF). PATIENTS AND METHODS Twelve patients with various bullous dermatoses (three pemphigus vulgaris, one pemphigus herpetiformis, three bullous pemphigoid (BP), two cicatricial pemphigoid (CP) and three epidermolysis bullosa acquisita (EBA)) were enrolled in the study. In 10 cases, MPA was administered in combination with systemic corticosteroids, while in two patients with severe diabetes mellitus MPA was employed as monotherapy. The total time on MPA varied from 2 to 8 months. Four patients were given MMF (2,000 mg daily), seven received EC-MPS (1,440 mg daily) and one received both sequentially. RESULTS Complete remission, lasting for a mean time of 6.1 months, was achieved in 10 patients. Partial remission was obtained in two patients with disseminated CP and EBA. Both MMF and EC-MPS were well tolerated, but the latter was better in terms of gastrointestinal adverse effects. CONCLUSIONS MPA may be proposed as a first-line adjuvant agent for pemphigus as well as for refractory BP and CP. MPA monotherapy has to be considered in selected cases of BP and pemphigus. The highly promising results obtained in EBA suggest a future key role for MPA in the management of this disease.
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Affiliation(s)
- Angelo V Marzano
- Institute of Dermatological Sciences, University of Milan, Milan, Italy.
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Mycophenolate mofetil in dermatology. J Am Acad Dermatol 2009; 60:183-99; quiz 200-2. [DOI: 10.1016/j.jaad.2008.08.049] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 08/01/2008] [Accepted: 08/11/2008] [Indexed: 11/17/2022]
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Gaudy-Marqueste C. Autres immunosuppresseurs : azathioprine (Imurel®), mycophénolate mofétil (Cellcept®), cyclophosphamide (Endoxan®). Ann Dermatol Venereol 2007; 134:949-56. [DOI: 10.1016/s0151-9638(07)78256-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Palaniappan S, Ford AC, Greer D, Everett SM, Chalmers DM, Axon ATR, Hamlin PJ. Mycophenolate mofetil therapy for refractory inflammatory bowel disease. Inflamm Bowel Dis 2007; 13:1488-92. [PMID: 17924566 DOI: 10.1002/ibd.20258] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Mycophenolate mofetil (MMF) is an immunomodulatory drug, and its use in inflammatory bowel disease has previously been reported. The aim of this study was to review the Leeds Colitis Clinic experience of the safety and efficacy of MMF in treating patients with refractory Crohn's disease (CD) and ulcerative colitis (UC). This is an extension of a previously published study from our center with a longer follow-up period and approximately twice the number of patients. METHODS A retrospective analysis was performed of the records of all patients treated with MMF for inflammatory bowel disease over a 5-year period. RESULTS Of 70 patients identified, 67 had previously been treated with azathioprine unsuccessfully. Seventeen of the 70 patients had been successfully maintained in remission with MMF for an average duration of 33 months. Treatment with MMF was discontinued for 53 patients, 17 because of side effects and 36 because they had not responded to the treatment. CONCLUSIONS In our series, 17 patients (24.3%) had a sustained steroid-free remission with MMF therapy. Nineteen patients (27%) experienced side effects, of which 17 (24.3% of the total group) had to discontinue therapy. An additional 36 (51.4%) required an escalation in medical therapy or surgery because of failure of the MMF therapy. MMF may have a role in the treatment of refractory inflammatory bowel disease, especially in patients who have previously failed standard therapies such as azathioprine.
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Affiliation(s)
- S Palaniappan
- Department of Gastroenterology, Leeds General Infirmary, Lees, United Kingdom
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Farhi D, Duriez P, Aractingi S, Cosnes J, Khosrotehrani K. Misleading pustular plaques of the lower limbs during Crohn's disease: two case reports. J Med Case Rep 2007; 1:109. [PMID: 17910771 PMCID: PMC2045104 DOI: 10.1186/1752-1947-1-109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2007] [Accepted: 10/03/2007] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Extraintestinal manifestations of Crohn's disease may involve the skin, the eyes, the genital mucosa, and the joints. Dermatoses associated with Crohn's disease include neutrophilic dermatoses, erythema nodosum, granulomatous dermatitis, blistering dermatoses, and non-specific skin manifestations. Cutaneous Crohn's disease is characterized by skin non-caseating epithelioid granulomatas with giant cells, remote from the gastrointestinal tract. We report herein two new cases. OBSERVATIONS On both patients, differential diagnosis of neutrophilic dermatoses and infectious disease were evoked, and antimicrobial agents were introduced in one of them. Given the atypical presentation, the final diagnosis of cutaneous Crohn's disease could only be made with histological examination. In patient 1, the plaques decreased in size and infiltration by more than 75% after 3 weeks of treatment with bethametasone dipropionate 0.05% cream. In patient 2, the plaques decreased by more than 50% after 6 weeks of treatment with prednisolone (45 mg/day) and azathioprine (100 mg/day). DISCUSSION Cutaneous Crohn's disease may present as dusky, erythematous, infiltrated, and ulcerated plaques and nodules. Female-to-male sex ratio is about 2, and the mean age at onset is 35. Recurrently, the hypothesis of a skin mycobacterial or fungal infection greatly delays proper treatment. Rarity of cutaneous Crohn's disease hampers therapeutic assessment in controlled trials. Thus, available literature is limited to case reports and sparse small series, with contradictory results. These reports are subject to publication bias, and no definite evidence-based recommendations can be made on the most adequate therapeutic strategy.
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Affiliation(s)
- David Farhi
- AP-HP, Hôpital Tenon, Department of Dermatology, Paris F-75020, France
| | - Paul Duriez
- AP-HP, Hôpital Saint Antoine, Department of Pathology, Paris F-75012, France
| | - Selim Aractingi
- AP-HP, Hôpital Tenon, Department of Dermatology, Paris F-75020, France
| | - Jacques Cosnes
- AP-HP, Hôpital Saint Antoine, Department of Gastroenterology, Paris F-75012, France
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Juillerat P, Christen-Zäch S, Troillet FX, Gallot-Lavallée S, Pannizzon RG, Michetti P. Infliximab for the treatment of disseminated pyoderma gangrenosum associated with ulcerative colitis. Case report and literature review. Dermatology 2007; 215:245-51. [PMID: 17823524 DOI: 10.1159/000106584] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Accepted: 03/15/2007] [Indexed: 12/16/2022] Open
Abstract
We report the case of a 19-year-old woman who developed an acute disseminated pyoderma gangrenosum (PG) during a severe flare of ulcerative colitis (UC). She was successfully treated with a 3-dose regimen of the anti-tumor-necrosis-factor-alpha antibody infliximab. The literature on the effectiveness of this biological agent was reviewed, including 8 other cases of UC-associated PG and 77 cases of Crohn's-disease-associated PG. This case report and the review of the literature demonstrate that infliximab can be successfully used to treat patients with PG associated with inflammatory bowel diseases.
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Affiliation(s)
- Pascal Juillerat
- Division of Gastroenterology and Hepatology, University of Lausanne, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Abstract
Autoimmune bullous diseases result from an immune response to molecular components of the desmosome or basement membrane. Bullous diseases are associated with a high degree of morbidity and occasional mortality. Therapy of bullous diseases consists of suppressing the immune system, controlling inflammation and improving healing of erosions. The therapeutic agents used in the treatment of bullous diseases may be associated with high morbidity and occasional mortality. Successful treatment requires understanding of the pathophysiology of the disease process and the pharmacology of the drugs being used.
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Affiliation(s)
- Diya F Mutasim
- Department of Dermatology, University of Cincinnati College of Medicine Cincinnati, OH, USA
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Affiliation(s)
- Douglas Kress
- Children's Hospital of Pittsburgh, Children's Dermatology Services, Wexford, Pennsylvania, USA
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Braun F, Behrend M. Basic immunosuppressive drugs outside solid organ transplantation. Expert Opin Investig Drugs 2006; 15:267-91. [PMID: 16503764 DOI: 10.1517/13543784.15.3.267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Immunosuppressive drugs are the backbone of solid organ transplantation. The introduction of new immunosuppressive drugs led to improved patient and organ survival rates. Nowadays, acute rejection can be reduced to a minimum. Individualization and avoidance of drug-related adverse effects became a new goal to achieve. The potency of immunosuppressive drugs makes them attractive for use in various autoimmune diseases; therefore, the experience on immunosuppressive drugs outside the field of organ transplantation is analysed in this review.
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Affiliation(s)
- Felix Braun
- General and Transplantation Surgery, University of Kiel, Germany
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Tran MM, Anhalt GJ, Barrett T, Cohen BA. Childhood IgA-mediated epidermolysis bullosa acquisita responding to mycophenolate mofetil as a corticosteroid-sparing agent. J Am Acad Dermatol 2006; 54:734-6. [PMID: 16546607 DOI: 10.1016/j.jaad.2005.07.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Revised: 06/28/2005] [Accepted: 07/04/2005] [Indexed: 11/19/2022]
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Abstract
Progress in understanding the pathogenesis and treatment of rheumatologic and glomerular diseases such as systemic lupus erythematosus and particularly lupus nephritis has been closely linked with the development of newer immunosuppressive agents. With improved patient survival following the institution of cyclophosphamide and corticosteroid therapy, longer-term management issues came to the forefront, especially how to decrease adverse effects of the immunosuppressive regimen. Many of the immunosuppressive regimens used in lupus patients were first established as efficacious and safe through their use in solid organ transplantation. Mycophenolate mofetil (MMF) is now widely used in the field of transplantation. Following anecdotal reports describing benefits of MMF in lupus and lupus nephritis patients, small studies and finally large randomized, controlled trials have established the use of MMF in these patients, particularly those with lupus nephritis. MMF use in other rheumatologic and renal diseases has been evaluated in only smaller studies and very few randomized controlled trials. Nevertheless, many studies currently are ongoing with this immunosuppressive agent. This article will review the published data and the experience of two major New York medical centers with the use of MMF in autoimmune and renal diseases.
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Affiliation(s)
- Gerald B Appel
- Department of Nephrology, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA.
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Ingen-Housz-Oro S, Prost-Squarcioni C, Pascal F, Doan S, Brette MD, Bachelez H, Dubertret L. [Cicatricial pemphigoid: treatment with mycophenolate mofetil]. Ann Dermatol Venereol 2005; 132:13-6. [PMID: 15746600 DOI: 10.1016/s0151-9638(05)79188-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The severity of cicatricial pemphigoid (CP) varies. First-intent treatment of mild or moderate cases is dapsone. In life or sight-threatening cases, intravenous cyclophosphamide pulses are efficient but may have digestive side effects and imply repeated hospitalizations. Mycophenolate mofetil (MMF) is an oral and well tolerated immunosuppressant agent which has proved its efficacy in pemphigus and some bullous pemphigoid. In CP, encouraging case reports have been previously published. We report herein a retrospective study about 14 patients who have received MMF since 2000. PATIENTS AND METHODS There were 5 men and 9 women, with a mean age of 69 years. MMF was introduced in 3 different clinical situations: immediately in relay to cyclophosphamide in 7 patients with severe CP (group I); in case of a mild-severe relapse at distance from with dranal of cyclophosphamide in 3 patients (group II); as first-intent immunosuppressant agent in 4 patients whose disease was not under control with high-dose dapsone, but not life - or sight-threatening (group III). In all these patients, the disease was invalidating and not controlled by dapsone +/- sulfasalazine, but did not threaten life or sight. The aim was to achieve satisfying control of the disease with an oral and well tolerated immunosuppressant agent, and to maintain good quality of life. The dose of MMF was 1.5 or 2 g per day. The criteria of MMF efficacy was the healing of previous lesions and the absence of new progressive lesions. RESULTS MMF was efficient in obtaining or maintaining a good control of the disease in 10/14 patients, as long as the underlying treatment with dapsone (2 mg/kg/d) was maintained. In 7/10 cases, it was possible to decrease the dapsone dose in order to improve hematological tolerance. In the 3 other cases, a relapse occurred when the dose of dapsone was decreased. MMF was inefficient in controling the disease in 4/14 patients (29 p. 100). Clinical and biological tolerance of MMF was good in 13/14 patients. DISCUSSION In this series, MMF was proposed to heterogenous patients, who presented at that time a mild-moderate disease and for whom we wanted in improve the quality of life. MMF seems to be an interesting drug, capable of obtaining or maintaining satisfactory control of the disease and permitting the decrease of dapsone doses in some mild-severe CP. However MMF must not replace cyclophosphamide in severe sight or life-threatening forms of CP.
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Kazlow Stern D, Tripp JM, Ho VC, Lebwohl M. The Use of Systemic Immune Moderators in Dermatology: An Update. Dermatol Clin 2005; 23:259-300. [PMID: 15837155 DOI: 10.1016/j.det.2004.09.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In addition to corticosteroids, dermatologists have access to an array of immunomodulatory therapies. Azathioprine, cyclophosphamide, methotrexate, cyclosporine, and mycophenolate mofetil are the systemic immunosuppressive agents most commonly used by dermatologists. In addition, new developments in biotechnology have spurred the development of immunobiologic agents that are able to target the immunologic process of many inflammatory disorders at specific points along the inflammatory cascade. Alefacept, efalizumab, etanercept, and infliximab are the immunobiologic agents that are currently the most well known and most commonly used by dermatologists. This article reviews the pharmacology, mechanism of action, side effects, and clinical applications of these therapies.
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Affiliation(s)
- Dana Kazlow Stern
- Department of Dermatology, Mount Sinai School of Medicine, New York, NY 10029-6574, USA
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Talwalkar JA, Angulo P, Keach JC, Petz JL, Jorgensen RA, Lindor KD. Mycophenolate mofetil for the treatment of primary sclerosing cholangitis. Am J Gastroenterol 2005; 100:308-12. [PMID: 15667487 DOI: 10.1111/j.1572-0241.2005.40484.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease of unknown etiology. Despite advances in understanding the pathophysiology underlying this disorder, no effective medical therapy has been identified for halting disease progression. The aim of this investigation was to determine the safety and estimated efficacy of mycophenolate mofetil (MMF) for the treatment of PSC. Thirty patients with PSC received MMF 1 g daily to a maximum of 3 g daily for 1 yr. Liver tests were determined at 3-month intervals with the Mayo risk score calculated at baseline and at the end of therapy. Twenty-three (77%) patients completed 1 yr of therapy. Significant but clinically marginal improvement in serum alkaline phosphatase level after 1 yr of therapy was observed (1135 +/- 581 U/L vs 912 +/- 463 U/L, p= 0.02). No other significant changes in liver biochemistries or Mayo risk score was observed. Seven patients (23%) discontinued MMF due to adverse events possibly related to therapy. Adverse reactions resolved spontaneously or with dose reduction in 10 (33%) patients. One patient developed pancreatitis, bacterial cholangitis, and sepsis during the eighth month of MMF therapy. No patient developed cytopenia on therapy. In conclusion, MMF does not appear to have clinically important benefits for PSC despite being tolerated by most patients. The results of this pilot study do not support further study of MMF as a single agent in the treatment of PSC.
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Affiliation(s)
- Jayant A Talwalkar
- Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, 200 SW First Street, Rochester, MN 55905, USA
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