mycophenolic-acid and Infertility--Male

Pemphigus can cause complications during pregnancy and may cause serious harm to a fetus. For this study, a comprehensive review of common treatments of pemphigus and their adverse effects associated with pregnancy and male fertility was conducted. We concluded that a period of remission with minimal or no therapy before conception could significantly reduce the risk of the disease flaring up, at least in the first trimester. The period of remission causes a delay in the flare-up of the disease, which means lower cumulative doses and the prevention of possible congenital abnormalities caused by corticosteroid or immunosuppressant treatments. All common treatments of pemphigus-azathioprine, mycophenolate mofetil, and methotrexate-should be avoided during pregnancy. However, it appears that systemic corticosteroids in a safe dose with a topical form of corticosteroids may be used without serious risk. Due to the lack of data associated with rituximab therapy, it is recommended that this drug be avoided 12 months before conception. It appears that the safest treatment of pemphigus is intravenous immunoglobulin (IVIg), which may be more effective when used with topical corticosteroids. Due to the delayed effect of IVIg, it should be used some months prior to conception.

Topics: Adrenal Cortex Hormones; Azathioprine; Female; Fetal Development; Humans; Immunoglobulins, Intravenous; Infertility, Male; Male; Methotrexate; Mycophenolic Acid; Pemphigus; Pregnancy; Pregnancy Complications; Skin

In the past decade, there has been enormous progress in the understanding of the pathomechanisms of immune-mediated diseases, which has led to major advances in immunotherapeutic strategies. As a consequence, the armamentarium of specific and nonspecific immune-modulating and immunosuppressive drugs for the treatment of skin diseases has been widely extended. Among the nonspecific immunomodulators, mycophenolate mofetil and leflunomide show promising effects in a variety of autoimmune and inflammatory skin disorders. Both compounds inhibit a key enzyme in nucleotide biosynthesis, a step that is pivotal for the production of cytotoxic T cells and antibody formation. They do not act in the nucleus, which may explain their advantageous side-effect profile.

Topics: Administration, Oral; Autoimmune Diseases; Female; Fertility; Fetal Death; Humans; Immunosuppressive Agents; Infertility, Male; Isoxazoles; Leflunomide; Male; Mycophenolic Acid; Pregnancy; Skin Diseases

Topics: Adolescent; Adult; Aged; Androgens; Australia; Birth Weight; Comorbidity; Female; Gestational Age; Humans; Immunosuppressive Agents; Infant, Newborn; Infertility, Male; Male; Middle Aged; Mycophenolic Acid; New Zealand; Postoperative Complications; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Registries; Renal Replacement Therapy; Semen Analysis; Young Adult

Mycophenolic acid (MPA) is the active immunosuppressive substance in both mycophenolate mofetil and mycophenolate sodium, and it is widely used after organ transplantation. In women, taking MPA is teratogenic and may also influence spermatogenesis. There is a lack of knowledge regarding outcome of pregnancies fathered by men exposed to MPA.. We compared outcomes in pregnancies fathered by renal transplant men per whether they had been exposed to MPA or not at time of conception. A nationwide population-based retrospective cohort study was performed. Data from the Norwegian Renal Registry with all renal transplanted men alive between January 1, 1995 and December 31, 2015 were included, and relevant outcome data were extracted from the Medical Birth Registry of Norway.. During the given time, 230 immunosuppressed renal transplanted men fathered 350 children (155 on MPA/195 not on MPA). There were no significant increased risks of malformation (3.9% vs. 2.6%, P = 0.49) in MPA exposed versus unexposed cohorts of children. The average dose (±SD) of mycophenolate was 1.42 ± 0.3 g/day and the individual median MPA trough concentration in the time period of anticipated conception and pregnancy was 2.8 ± 1.6 mg/L. Birth weight was similar in exposed and unexposed cohorts of children; 3381 ± 681 g vs. 3429 ± 714 g (P = 0.53).. Paternal exposure to MPA did not increase the risk of adverse birth outcomes in children fathered by male kidney transplanted patients. These results are reassuring and support the continuation of paternal MPA treatment before, during, and after conception.

Topics: Adult; Birth Weight; Female; Fertility; Gestational Age; Humans; Immunosuppressive Agents; Infertility, Male; Kidney Transplantation; Live Birth; Male; Mycophenolic Acid; Norway; Pregnancy; Pregnancy Complications; Pregnancy Rate; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome

Adverse effects of mTOR inhibitors on spermatogenesis are poorly evaluated but hypogonadism is described under sirolimus. We report the case of a renal transplant 30 years old patient in whom azoospermia was discovered while he was being treated by everolimus.

Topics: Adrenal Cortex Hormones; Adult; Antibodies, Monoclonal; Azoospermia; Basiliximab; Causality; Cyclosporine; Drug Substitution; Everolimus; Graft Rejection; Humans; Immunosuppressive Agents; Infertility, Male; Kidney Transplantation; Male; Mycophenolic Acid; Recombinant Fusion Proteins; Sirolimus; Spermatogenesis; TOR Serine-Threonine Kinases