Psoriasis mycophenolate mofetil

Systemic therapies are seldom used for mild to moderate psoriasis, and are generally reserved for patients with moderate to severe psoriasis.17 29 Oral agents include sulfasalazine, acitretin, methotrexate, cyclosporine, mycophenolate mofetil, azathioprine, tacrolimus, and hydroxyurea. Parenteral agents include the biologic response modifiers alefacept, efalizumab, etanercept, infliximab, and many others, currently at various stages of research or approval for psoriasis. 

Mycophenolate mofetil in doses of 1 to 1.5 g twice daily (maximum dose 3 g/day) is effective as adjunctive therapy in patients with resistant psoriasis on cyclosporine.29,38 As monotherapy, there may be some benefit in patients with moderate psoriasis and psoriatic arthritis, but not in severe psoriasis.29... 

Mycophenolate mofetil (CellCept) inhibits DNA and RNA synthesis and has been shown to have a specific lymphocyte antiproliferative effect. Although not FDA approved for this indication, oral mycophenolate mofetil appears effective in the treatment of moderate to severe plaque psoriasis. The usual dose is 500 mg orally four times a day, up to a maximum of 4 g/day. Common adverse effects include GI toxicity (diarrhea, nausea, vomiting), hematologic effects (anemia, neutropenia, thrombocytopenia), and viral and bacterial infections. Lymphoproliferative disease or lymphoma has been reported. 

Cyclosporine is an important drng in preventing rejection after kidney, liver, heart and other organ transplantation (Haberal et al., 2004). Cyclosporine nsnally is combined with other immnnosnppressives especially glncocorticoids and either azathioprine or mycophenolate mofetil and sirolimns (Krensky et al., 2005). In renal allotransplants it has improved graft acceptance in most clinics to 95 percent. In addition to its nse in transplantation cyclosporine is used for the treatment of a number of autoimmune diseases. In autoimmune diseases, as might be anticipated, cyclosporine is most effective in those which are T cell mediated. These include several forms of psoriasis, rheumatoid arthritis refractive to all other therapy, uveitis, nephrotic syndrome and type I diabetes meUitus. 

Mycophenolate mofetil, the morphohnoethyl ester of mycophenolic acid (rINN), is an antimetabohte that interferes with the synthesis of nucleic acids and selectively inhibits the proliferation of T and B lymphocytes. It has been used to treat psoriasis and to prevent acute renal allograft rejection in combination with ciclosporin and glucocorticoids. 

Davison SC, Morris-Jones R, Powles AV, Fry L. Change of treatment from cyclosporin to mycophenolate mofetil in severe psoriasis. Br J Dermatol 2000 143 405-407. 

Mycil chlorphenesin tolnafitate. mycophenolate mofetil [usan] (CellCept ) is converted in vivo to n cophenolic add, which has antimetabolite cytotoxic properties. It shows experimental activity as an ANTICANCER and ANTIVIRAL AGENT. It may be clinically useful in treating psoriasis and as an ANTU.EISHMANIAL. It shows IMMUNOSUPPRESSANT properties, and is used in the prophylaxis of acute kidney rejection, mycophenolic acid [ban, inn, usan] is usually... 

Mycophenolate mofetil, a semisynthetic morpholinoester of my-cophenolic acid, initially was used to prevent acute rejection after renal and cardiac transplantation, but it is now used as part of combination therapy in moderate to severe psoriasis and other autoimmune dermatoses. It reversibly blocks de novo synthesis of guanine nucleotides required for DNA and RNA synthesis. The drug has been shown to have a speciflc lymphocyte antiproliferative effect. Oral mycophenolate mofetil, as well as topical mycophenolic acid, may undergo further clinical studies to establish efficacy in the treatment of patients with severe psoriasis. " ... 

Kirby B, Yates VM. Mycophenolate mofetil for psoriasis. Br J Dermatol 1998 139 357. 

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