mycophenolic-acid and Cushing-Syndrome

The treatment of SLE remains complex, and management is constrained by a lack of safe, effective, targeted therapies. Physicians, also, are constrained by a lack of evidence-based approaches with existing agents, including glucocorticoids, utilized in the majority of patients. While Cushingoid side effects of glucocorticoids are widely recognized, emerging literature now suggests that glucocorticoid use actually contributes to harmful outcomes in SLE, over and above these effects. These studies provide a compelling case for a re-evaluation of the long-term use of glucocorticoids in SLE, focusing on minimizing glucocorticoid exposure as part of the strategy to improve long-term outcomes. In this article, we review the evidence for the harmful effects of glucocorticoids in SLE, and propose therapeutic options that reduce reliance on glucocorticoids. We propose that it is time for the lupus community to have a louder conversation about glucocorticoid use, and for any residual complacency about their risk-benefit ratio to be banished.

Topics: Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Azathioprine; Cardiovascular Diseases; Cataract; Cushing Syndrome; Diabetes Mellitus; Disease Progression; Evidence-Based Medicine; Glucocorticoids; Humans; Hydroxychloroquine; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Mycophenolic Acid; Osteonecrosis; Osteoporotic Fractures

Pemphigus is a serious, potentially fatal chronic autoimmune bullous disease with cutaneous and mucosal manifestations. Early diagnosis and treatment are essential.. We performed a retrospective cohort study that included patients diagnosed with pemphigus in the dermatology department of Hospital Universitario Virgen Macarena, Seville, Spain, in 2005 and 2006. We reviewed demographic, clinical, and therapeutic data.. Twenty-three patients, the majority women, were included in the study. Clinical onset usually occurred between 30 and 60 years of age. The most common variant was pemphigus vulgaris (79 %), and the sites most frequently affected were the oral mucosa, trunk, and scalp. Oral corticosteroids were the initial treatment of choice in all patients, and azathioprine and mycophenolate mofetil were given as adjuvant therapy. Complete remission was induced in 8.68 % of patients and partial remission in 91.32 %. The main complications were infections, osteopenia and osteoporosis, and cataracts.

Topics: Adrenal Cortex Hormones; Adult; Aged; Azathioprine; Cushing Syndrome; Drug Therapy, Combination; Female; Hospitals, University; Hospitals, Urban; Humans; Hypertension; Immunosuppressive Agents; Infections; Male; Methotrexate; Middle Aged; Mycophenolic Acid; Pemphigus; Retrospective Studies; Spain