mycophenolic-acid and Psoriasis

For patients with moderate to severe psoriasis, there is a large range of variably effective and safe oral, systemic medications. With appropriate monitoring, these therapies may be used as either monotherapy or in combination with other therapies. Newer drugs in the research pipeline hold significant promise.

Topics: Acitretin; Anti-Inflammatory Agents, Non-Steroidal; Antimetabolites; Cyclosporine; Fumarates; Humans; Hydroxyurea; Immunosuppressive Agents; Isoxazoles; Keratolytic Agents; Leflunomide; Methotrexate; Mycophenolic Acid; Piperidines; Protein Kinase Inhibitors; Psoriasis; Pyrimidines; Pyrroles; Sulfasalazine; Thalidomide; Thioguanine

Many studies have identified cardiovascular risk factors in patients with psoriasis. Some psoriasis therapies may increase cardiovascular disease (CVD) and others may decrease CVD.. We reviewed the literature to define the impact of common psoriasis therapies on cardiovascular measures and outcomes.. Phototherapy has no major cardiovascular impact and may reduce levels of proinflammatory cytokines. Acitretin increases serum lipids and triglycerides, but has not been shown to increase cardiovascular risk. Cyclosporine A increases blood pressure, serum triglycerides, and total cholesterol. Methotrexate is associated with a decreased risk of CVD morbidity and mortality. Among the biologics, data for tumor necrosis factor inhibitors suggest an overall reduction in cardiovascular events. Most data on short-term ustekinumab use suggest no effect on major adverse cardiovascular events, however some authorities remain concerned. Nevertheless, ustekinumab use over a 4-year period shows a decrease in major adverse cardiovascular events when compared both with the general US population and with psoriatics in Great Britain.. Most studies lack the power and randomization of large clinical trials and long-term follow-up periods. In addition, the increased risk of CVD associated with psoriasis itself is a confounding factor.. Some therapies for moderate to severe psoriasis, including methotrexate and tumor necrosis factor inhibitors, may reduce cardiovascular events in psoriatic patients. Ustekinumab appears to be neutral but there may be a long-term benefit. Appropriate patient counseling and selection and clinical follow-up are necessary to maximize safety with these agents. Further long-term study is necessary to quantify the benefits and risks associated with biologic therapies.

Topics: Acitretin; Antibodies, Monoclonal, Humanized; Biological Therapy; Cardiovascular Diseases; Cyclosporine; Humans; Immunosuppressive Agents; Keratolytic Agents; Methotrexate; Mycophenolic Acid; Psoriasis; PUVA Therapy; Tumor Necrosis Factor-alpha; Ustekinumab

Acrodermatitis continua of Hallopeau (ACH) is a rare acropustular eruption, characterized by sterile pustules, paronychia and atrophic skin changes, onychodystrophy and osteolysis of the distal phalanges of the fingers and toes. It is considered to be a variant of pustular psoriasis with a chronic relapsing course and frequent refractoriness to many therapeutic modalities, which can be amenable to successful treatment by tumor necrosis factor alpha antagonists. We report 1 patient with pustular psoriasis and ACH whom we have treated successfully with etanercept (for 30 months) and then adalimumab (for 13 months and ongoing). Blanching was initially achieved with etanercept 50 mg twice a week, but suppression of periungual inflammation then required combination therapy with etanercept 50 mg twice a week and methotrexate 10 mg weekly; lower doses of both drugs did not allow complete control of the disease. Eventually, adalimumab 40 mg every 2 weeks has provided the most cost-effective response in this patient, allowing maintenance of response with partial nail regrowth under monotherapy.

Topics: Acitretin; Acrodermatitis; Adalimumab; Aged; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Betamethasone; Clobetasol; Cyclosporine; Drug Therapy, Combination; Etanercept; Female; Humans; Immunoglobulin G; Methotrexate; Mycophenolic Acid; Nails; Paronychia; Psoriasis; Receptors, Tumor Necrosis Factor; Tumor Necrosis Factor Inhibitors

There are multiple therapeutic options for the treatment of moderate to severe psoriasis. The process of choosing among potential treatment options requires both the physician and the patient to weigh the benefits of individual modalities against their potential risks. Traditional systemic therapies for psoriasis, including methotrexate (MTX) and cyclosporine (CsA), have a well-documented array of toxicities, particularly end-organ toxicities. Over the past several years, the use of biologic therapies for the treatment of moderate to severe psoriasis has been a major clinical and research focus. With the advent of these novel immunosuppressive therapies, one of the central safety issues surrounding these agents is their potential to increase the risk of malignancy.. Our objective was to review the risk of malignancy associated with therapies for moderate to severe psoriasis, including phototherapy, traditional systemic therapies, and biologic therapies. We reviewed the existing body of literature in order to define the known incidence of malignancy associated with psoralen and ultraviolet A (PUVA), narrowband and broadband ultraviolet B (UVB), MTX, CsA, mycophenolate mofetil (MMF), and biologic therapies, including alefacept, efalizumab, infliximab, etanercept, adalimumab, and ustekinumab.. PUVA, when given long term, is associated with increased risks of cutaneous squamous cell carcinoma and malignant melanoma. Reviews of studies on UVB, both narrowband and broadband, do not indicate any increased risk of nonmelanoma skin cancer or melanoma. The traditional systemic psoriasis therapies-MTX, CsA, and MMF-may be associated with an increased risk of lymphoproliferative disorders during treatment, demonstrated in clinical trials in patients with rheumatoid arthritis and documented in case reports concerning psoriasis patients. The risk of malignancy with biologic therapy is still unclear. However, the majority of studies examining this carcinogenic risk suggest that tumor necrosis factor-alpha inhibitors may cause a slightly increased risk of cancer, including nonmelanoma skin cancer and hematologic malignancies.. The majority of studies cited in this review lack the power and randomization of large clinical trials, as well as the long-term follow-up periods which would further substantiate the hypothetical link between these antipsoriatic treatment regimens and the potential for malignancy. Because of the substantial lack of clinical data, the majority of studies evaluated focus on the treatment of patients with rheumatoid arthritis, which is a systemic inflammatory disorder comparable to psoriasis. Additionally, the increased risk of malignancy associated with psoriasis itself is a confounding factor.. Many of the therapies for moderate to severe psoriasis, including PUVA, traditional systemic therapies, and some biologic therapies, may increase the risk of malignancy. Appropriate patient counseling and selection, as well as clinical follow-up, are necessary to maximize safety with these agents. Further long-term study is necessary to more precisely quantify the risks associated with biologic therapies.

Topics: Biological Products; Cyclosporine; Dermatologic Agents; Humans; Methotrexate; Mycophenolic Acid; Psoriasis; PUVA Therapy; Skin Neoplasms; Ultraviolet Therapy

The prevailing notion in dermatology is that mycophenolate mofetil (MMF) is safer than cyclosporine (CsA), but that CsA has greater efficacy. This literature review evaluates the available long-term safety data of MMF and CsA. Literature in the fields of dermatology, autoimmune disease, and transplantation were retrieved from PubMed. Data regarding immunosuppressive and non-immunosuppressive side effects of MMF and CsA are presented along with available pregnancy safety data. Surprisingly, there is a paucity of data on long-term MMF monotherapy. Transplant data is presented separately due to the concomitant use of other immunosuppressants along with MMF. Trends that can be identified include a less discernable cancer or end-organ damage risk in MMF compared to CsA. However, MMF appears to have a greater risk in pregnancy and increased reports of herpes simplex and zoster infection compared to CsA.

Topics: Adult; Cyclosporine; Dermatologic Agents; Female; Humans; Immunosuppressive Agents; Infections; Long-Term Care; Mycophenolic Acid; Neoplasms; Pregnancy; Psoriasis; Safety

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.

Topics: Dermatitis, Atopic; Humans; Immunosuppressive Agents; Lupus Erythematosus, Cutaneous; Mycophenolic Acid; Psoriasis; Pyoderma Gangrenosum; Skin Diseases, Vesiculobullous

Immune response modifiers (IRMs) are agents that target the body's immune system (i.e., cytokines, receptors, and inflammatory cells) to combat disease. Topical IRM therapies, which encompass both proinflammatory and immunosuppressive therapeutics, have been used to successfully treat a number of dermatologic conditions. Proinflammatory treatments include Toll-like receptor agonists (e.g., imiquimod 5% cream) and interferon (e.g., interferon-alpha) therapies, which have been used in the treatment of external genital warts, basal cell carcinoma, and other dermatologic diseases. Immunosuppressive therapies include topical and intralesional corticosteroids, anti-tumor necrosis factor agents (e.g., infliximab and etanercept), and anti-CD4+ T-cell agents, including calcineurin inhibitors and mycophenolate. These agents have been used to treat a number of conditions, including atopic and seborrheic dermatitis and psoriasis. This article reviews the mechanism of action of IRMs and the application of IRMs in several dermatologic diseases.

Topics: Adjuvants, Immunologic; Alefacept; Aminoquinolines; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Calcineurin Inhibitors; CD11 Antigens; Dermatitis, Atopic; Glucocorticoids; Humans; Imiquimod; Interferons; Membrane Glycoproteins; Mycophenolic Acid; Psoriasis; Receptors, Cell Surface; Recombinant Fusion Proteins; Skin Diseases; Tacrolimus; Toll-Like Receptors

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.

Topics: Dose-Response Relationship, Drug; Drug Administration Schedule; Eczema; Female; Graft vs Host Disease; Humans; Lichen Planus; Male; Mycophenolic Acid; Pregnancy; Psoriasis; Pyoderma Gangrenosum; Randomized Controlled Trials as Topic; Risk Assessment; Skin Diseases; Skin Diseases, Vesiculobullous; Treatment Outcome

There is a high medical need for better therapies for psoriasis. Based on new insight into the pathophysiology of this frequent immune disease, a number of novel systemic immunomodulatory therapies are currently in clinical development. These include approaches targeting antigen presentation and costimulation, T cell activation and leukocyte adhesion, action of proinflammatory mediators, and modulating the cytokine balance. Although mainly only preliminary data are available so far, these trials contribute to a further understanding of the disease and will eventually lead to new therapeutic options for psoriasis. Moreover, since psoriasis can be considered as a visible model disease for T cell-mediated disorders characterized by a type 1 cytokine pattern in general, such approaches may have impact for other immune disorders as well. Here we review the rationale and the initial clinical data of these important recent experimental therapies.

Topics: Antibodies, Monoclonal; Calcitriol; Cytokines; Dimethyl Fumarate; Fumarates; Humans; Immunotherapy; Mycophenolic Acid; Psoriasis; Receptors, Leukotriene B4; T-Lymphocytes

Mycophenolate mofetil represents a new immunosuppressive drug. Several case reports have shown that mycophenolate mofetil has a good therapeutic effect in patients with psoriasis and autoimmune dermatoses. Mycophenolate mofetil is a morpholine ester of mycophenolic acid which was shown in the 1970s to be effective in patients with severe psoriasis. Mycophenolate mofetil has an increased bioavailability as compared to mycophenolic acid and thereby an improved therapeutic window. Currently, mycophenolate mofetil is indicated for the prevention of organ rejection in transplant patients. The mode of action and the pharmacology of mycophenolate mofetil are reviewed and the current clinical experience with this immunosuppressive drug for dermatological disorders is summarized.

Topics: Administration, Oral; Animals; Autoantibodies; Autoimmune Diseases; Clinical Trials as Topic; Humans; Immunosuppressive Agents; Mycophenolic Acid; Psoriasis; Skin Diseases; Treatment Outcome

Oral mycophenolic acid (MPA) therapy has been investigated in the treatment of moderate to severe psoriasis since the early 1970s and has been found to be both safe and effective. By inhibiting de novo purine biosynthesis, it functions as an antifungal, antibacterial, antiviral, and immunosuppressive agent. The recent availability of mycophenolate mofetil (MMF), a morpholinoester of MPA, has created renewed interest in the antipsoriatic properties of MPA. MMF is currently indicated for the prevention of organ rejection in transplant recipients and is used concomitantly with cyclosporine and corticosteroids. This review focuses on the pharmacology of MPA and MMF, studies of MPA in the treatment of psoriasis, and therapy with MMF. There is a potential application of MMF in the treatment of severe psoriasis and other inflammatory dermatoses, as well as topical MPA for the treatment of psoriasis.

Topics: Humans; Immunosuppressive Agents; Mycophenolic Acid; Psoriasis; Skin Diseases

Topics: Administration, Topical; Anthralin; Azathioprine; Azauridine; Chemical Phenomena; Chemistry; Humans; Hydroxyurea; Mercaptopurine; Mustard Compounds; Mycophenolic Acid; Psoriasis

Topics: Alkylating Agents; Antimetabolites, Antineoplastic; Antineoplastic Agents; Azauridine; Cell Division; Female; Humans; Hydroxyurea; Kinetics; Methotrexate; Methoxsalen; Mycophenolic Acid; Psoriasis; Ultraviolet Therapy

Topics: Azauridine; Central Nervous System; Digestive System; Hematopoietic System; Humans; Hydroxyurea; Liver; Methotrexate; Mycophenolic Acid; Psoriasis

Methotrexate (MTX) is a well-known systemic drug for moderate to severe chronic plaque psoriasis. Recently, mycophenolate mofetil (MMF) has been recommended for psoriasis.. To compare the efficacy and safety of MMF vs. MTX for the treatment of chronic plaque psoriasis.. Thirty-eight consecutive patients with Psoriasis Area and Severity Index (PASI)>10 were randomly assigned for 12 weeks of treatment with either MTX (18 patients; initial dose, 7.5 mg/week) or MMF (20 patients; dose; 2 g/day) and were followed for 12 weeks after discontinuing the treatment. The differences between the two groups were analysed at the end of treatment and follow-up comparing with baseline values.. After 12 weeks of treatment, the mean ± SD score for the PASI decreased from 16.46 ± 5.29 at baseline to 3.17 ± 2.35 among 15 patients treated with MTX, whereas the score decreased from 17.43 ± 7.42 to 3.97 ± 5.95 among 17 patients treated with MMF (P>0.05). Twelve weeks after discontinuing the treatment, the scores were 4.77 ± 3.52 and 5.94 ± 4.27, respectively (P>0.05). PASI -75 were achieved in 58.8% of patients in MMF group and 73.3% in MTX group (P > 0.05). Three months after discontinuing the treatment, PASI-75 remained in 33.3% of patients in MMF and 53.3% of MTX group (P > 0.05). Both drugs were well tolerated and side-effects were minor and transient.. No significant differences in efficacy were found between MTX and MMF groups. MMF may represent a good alternative for the treatment of psoriasis in patients who are unable to take MTX or other available drugs due to contraindication or toxicity.

Topics: Adolescent; Adult; Chronic Disease; Dermatologic Agents; Female; Humans; Male; Methotrexate; Middle Aged; Mycophenolic Acid; Psoriasis; Treatment Outcome; Young Adult

To compare the efficacy of ciclosporine (CsA) versus mycophenolate mofetil (MMF) in psoriasis, a randomized trial was conducted.. A prospective multicenter randomized open-label clinical trial was performed to compare two parallel groups of patients with chronic plaque psoriasis undergoing different treatments. Therefore, a total of 54 patients with psoriasis were randomly assigned to treatment with either CsA (2.5 mg/kg body weight) or MMF (2 g daily) for 12 weeks, and the drug doses were adjusted according to response. The psoriasis area and severity index (PASI) was used to assess the clinical severity of psoriasis. The primary outcome of this trial was the time to disease relapse. Safety, PASI scores and psoriasis disability index (PDI) were assessed as secondary outcome.. There was no difference in time to disease relapse between the two groups. After 12 weeks of treatment, the mean PASI score (+/-SD) decreased from 24.6 +/- 11.1 to 6.6 +/- 7.3 in the CsA group (n = 27) and from 22.4 +/- 9.2 to 10.6 +/- 6.7 in the MMF group (n = 27; p = 0.02). The side effects, time to remission and PDI were similar in both groups.. After 12 weeks, CsA demonstrated a significantly superior efficacy in psoriasis compared to MMF.

Topics: Adult; Cyclosporine; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Male; Middle Aged; Mycophenolic Acid; Probability; Prospective Studies; Psoriasis; Risk Assessment; Severity of Illness Index; Treatment Outcome

There are numerous studies that individually evaluate the efficacy/effectiveness and toxicity of drugs in the systemic treatment of psoriasis. On the contrary, we can hardly find studies that compare each other.. To evaluate and compare the effectiveness and toxicity of mycophenolate mofetil and cyclosporin in chronic plaque psoriasis through a prospective, sequential, cross-over, non-randomized, two-phase, open-label study.. Eight patients (five women and three men; mean age 57, range 35-78) with moderate-to-severe chronic plaque psoriasis were included in the study. They were treated with oral mycophenolate mofetil (30 mg/kg/day) over a period of 16 weeks. Following a variable washout period and after a new outbreak of the disease, oral cyclosporin was introduced at a dose of 4 mg/kg/day. During both treatment regimens, follow-up visits were performed at 3, 8 and 16 weeks.. In both groups, the PASI started to decrease once treatment was begun. Cyclosporin was faster and statistically a lot more effective than mycophenolate mofetil, reaching a higher number of complete remissions and better percentages of PASI improvement from baseline (45.7%, 60.2% and 60.5% at 3, 8 and 16 weeks respectively for mycophenolate mofetil, and 89.7%, 95.3% and 95.3% respectively at the same intervals for cyclosporin). Cyclosporin was also more predictable in its action as the percentage of improvement along the follow-up visits had a much wider range for mycophenolate mofetil. Overall, the tolerability of both drugs was good. None of the patients had to discontinue treatment because of an adverse event. Two patients treated with cyclosporin showed increased plasma levels of creatinine.. Cyclosporin is more effective, fast, and predictable in its effect than mycophenolate mofetil to control moderate-to-severe chronic plaque psoriasis. Both drugs are well tolerated in short courses of treatment.

Topics: Adult; Aged; Chronic Disease; Cross-Over Studies; Cyclosporine; Dermatologic Agents; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Mycophenolic Acid; Prospective Studies; Psoriasis

Evidence that was obtained in several experimental models and in strains of hypertensive rats indicates that infiltration of inflammatory cells and oxidative stress in the kidney play a role in the induction and maintenance of hypertension. Similar evidence is lacking in human hypertension, at least in part, because immunosuppressive treatment is unjustified in patients with hypertension. For addressing this issue, patients who were prescribed by their private physicians mycophenolate mofetil (MMF) for the treatment of psoriasis or rheumatoid arthritis and had, in addition, grade I essential hypertension and normal renal function were studied. Eight patients were studied before MMF was started, during MMF treatment, and 1 mo after MMF treatment had been discontinued. Other treatments and diet were unchanged in the three phases of the study. MMF therapy was associated with a significant reduction in systolic, diastolic, and mean BP. Urinary excretion of TNF-alpha was reduced progressively by MMF treatment and increased after MMF was discontinued. Reduction of urinary malondialdehyde, TNF-alpha, and RANTES excretion during MMF administration did not reach statistical significance but had a direct positive correlation with the BP levels. These data are consistent with the hypothesis that renal immune cell infiltration and oxidative stress play a role in human hypertension.

Topics: Aged; Arthritis, Rheumatoid; Blood Pressure; Chemokine CCL5; Dose-Response Relationship, Drug; Female; Humans; Hypertension; Immunosuppressive Agents; Inflammation; Male; Middle Aged; Mycophenolic Acid; Psoriasis; Tumor Necrosis Factor-alpha

Mycophenolate mofetil (MMF) is a novel immunosuppressive drug. Several case reports have suggested that MMF has a beneficial effect in patients with psoriasis and autoimmune dermatoses.. To investigate the efficacy and safety of oral MMF in severe psoriasis.. Eleven patients with severe stable plaque-type psoriasis and a Psoriasis Area and Severity Index (PASI) between 12 and 53 (mean 30.5) were included in the study. They received oral MMF 1 g twice daily for 3 weeks and then 0.5 g twice daily for 3 weeks. The PASI were determined at baseline (week 0) and after 1, 2, 3 and 6 weeks of treatment.. Within 3 weeks of this therapy there was a reduction in PASI of between 40% and 70% in seven of 11 patients, and only one patient achieved a reduction in PASI of < 25% from baseline (mean PASI 15.6). Reducing MMF from 2 g daily to 1 g daily led to further, although only slight, improvement in six of 11 patients during the following 3 weeks. In four of 11 patients, the PASI increased at this lower dosage, and in one patient the drug was withdrawn because of muscle pain, which was possibly drug induced. This side-effect reversed within a few days after stopping the drug. Other side-effects, especially gastrointestinal and haematological toxicity, were not observed in any of the 11 patients treated. Overall, the mean PASI was 16.1 after 6 weeks.. We conclude that the immunosuppressant MMF 2 g daily is effective and safe in the treatment of severe psoriasis.

Topics: Administration, Oral; Adult; Aged; Dermatologic Agents; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Muscular Diseases; Mycophenolic Acid; Psoriasis; Severity of Illness Index; Treatment Outcome

Mycophenolic acid is effective for systemic treatment of psoriasis. However, there is no report about its topical use in this cutaneous disorder so far. We undertook a randomized, placebo-controlled, within subject comparison of mycophenolic acid 1% incorporated in an ointment base and the corresponding vehicle alone (placebo) using the psoriasis plaque test in 7 patients with plaque-type psoriasis over a period of 3 weeks. Scoring of erythema and induration was performed 3 times weekly. After 3 weeks of occlusive treatment there was a reduction of the sum score for erythema and induration in the mycophenolic acid-treated sites of 23% and of 5.7% in the vehicle-treated sites, which was not statistically significant. No adverse advents were noted during the time of study. We conclude that mycophenolic acid is ineffective when applied topically in psoriasis even under occlusion.

Topics: Adult; Aged; Double-Blind Method; Humans; Immunosuppressive Agents; Male; Middle Aged; Mycophenolic Acid; Psoriasis

The efficacy of orally administered mycophenolic acid (MPA), an inhibitor of guanosine monophosphate (GMP) synthesis, for the treatment of psoriasis, was studied in a double-blind fashion. Of twenty-one patients completing the study period, ten of eleven patients treated with MPA had a greater than 25% decrease in severity score compared with only two of ten patients treated with placebo. The placebo group had a slight increase in severity score compared to almost 50% reduction in the average severity score of the MPA-treated group. After termination of the double-blind portion of the study, the placebo group was treated with MPA and showed a 60% decrease in severity score. Adverse effects encountered included anorexia, nausea, vomiting, and diarrhea. One patient had an uncomplicated episode of herpes zoster. Other than a mild decrease hemoglobin, no hematologic toxicity was noted.

Topics: Adult; Aged; Clinical Trials as Topic; Dose-Response Relationship, Drug; Double-Blind Method; Female; Gastrointestinal Diseases; Humans; Male; Middle Aged; Mycophenolic Acid; Placebos; Psoriasis

Mycophenolic acid (MPA) is a fermentation product of a penicillium mould which has shown antitumour acitivity in certain animal models. It blocks nucleic acid synthesis by interfering with the interconversions of inosine monophosphate (IMP), xanthine monophosphate (XMP) and guanine monophosphate (GMP) thereby inhibiting growth and/or replication of tumour cells. In vivo activity depends on the presence of a beta-glucuronidase which is abundant in the cell wall of epithelial tissues. Encouraged by results obtained in earlier clinical trials, we have studied 28 patients with psoriasis, 21 in double-blind fashion. A comparison of disease severity in patients before and after receiving MPA versus patients receiving placebo clearly showed the superiority of drug over placebo. The mean severity score of patients receiving MPA as an initial course of therapy improved by 56% versus 9% in patients receiving placebo. Patients receiving MPA after an initial course of placebo therapy showed improvement in their mean severity score averaging 86%. Those patients receiving placebo after an initial course of MPA showed worsening of their mean severity score averaging 70%. Overall, about 75% of MPA treated patients have shown good to excellent responses, and toxicity appears low. Evidence suggests that MPA may be very useful in treating severe psoriasis.

Topics: Adult; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Middle Aged; Mycophenolic Acid; Psoriasis

Mycophenolic acid is an antimetabolite used experimentally for the treatment of psoriasis. Thirty-eight patients were treated with mycophenolic acid. A double-blind, placebo-controlled study demonstrated the efficacy of mycophenolic acid (P less than .01). A long-term safety study showed the occurrence of hematologic abnormalities, viral infections, and carcinoma. The position of mycophenolic acid in the therapeutic treatment of psoriasis must await the results of a multicenter cooperative study.

Topics: Adolescent; Adult; Aged; Breast Neoplasms; Carcinoma, Squamous Cell; Clinical Trials as Topic; Double-Blind Method; Epiglottis; Female; Humans; Laryngeal Neoplasms; Male; Middle Aged; Mycophenolic Acid; Psoriasis; Virus Diseases

Topics: Azathioprine; Cross-Sectional Studies; Cyclosporine; Dermatitis, Atopic; Drug Eruptions; Drug Monitoring; Humans; Methotrexate; Mycophenolic Acid; Psoriasis; United States

Topics: Administration, Cutaneous; Administration, Oral; Adult; Aged; Aged, 80 and over; Autoimmune Diseases; Cyclosporine; Disease Management; Enzyme Inhibitors; Female; Glucocorticoids; Humans; Hydroxyurea; Immunosuppressive Agents; Male; Methotrexate; Middle Aged; Mycophenolic Acid; Pemphigoid, Bullous; Pemphigus; Psoriasis; Retrospective Studies; Ultraviolet Therapy

Therapy-related myeloid neoplasms are a potentially life-threatening consequence of treatment for autoimmune disease (AID) and an emerging clinical phenomenon.. To query the association of cytotoxic, anti-inflammatory, and immunomodulating agents to treat patients with AID with the risk for developing myeloid neoplasm.. This retrospective case-control study and medical record review included 40 011 patients with an International Classification of Diseases, Ninth Revision, coded diagnosis of primary AID who were seen at 2 centers from January 1, 2004, to December 31, 2014; of these, 311 patients had a concomitant coded diagnosis of myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). Eighty-six cases met strict inclusion criteria. A case-control match was performed at a 2:1 ratio.. Odds ratio (OR) assessment for AID-directed therapies.. Among the 86 patients who met inclusion criteria (49 men [57%]; 37 women [43%]; mean [SD] age, 72.3 [15.6] years), 55 (64.0%) had MDS, 21 (24.4%) had de novo AML, and 10 (11.6%) had AML and a history of MDS. Rheumatoid arthritis (23 [26.7%]), psoriasis (18 [20.9%]), and systemic lupus erythematosus (12 [14.0%]) were the most common autoimmune profiles. Median time from onset of AID to diagnosis of myeloid neoplasm was 8 (interquartile range, 4-15) years. A total of 57 of 86 cases (66.3%) received a cytotoxic or an immunomodulating agent. In the comparison group of 172 controls (98 men [57.0%]; 74 women [43.0%]; mean [SD] age, 72.7 [13.8] years), 105 (61.0%) received either agent (P = .50). Azathioprine sodium use was observed more frequently in cases (odds ratio [OR], 7.05; 95% CI, 2.35- 21.13; P < .001). Notable but insignificant case cohort use among cytotoxic agents was found for exposure to cyclophosphamide (OR, 3.58; 95% CI, 0.91-14.11) followed by mitoxantrone hydrochloride (OR, 2.73; 95% CI, 0.23-33.0). Methotrexate sodium (OR, 0.60; 95% CI, 0.29-1.22), mercaptopurine (OR, 0.62; 95% CI, 0.15-2.53), and mycophenolate mofetil hydrochloride (OR, 0.66; 95% CI, 0.21-2.03) had favorable ORs that were not statistically significant. No significant association between a specific length of time of exposure to an agent and the drug's category was observed.. In a large population with primary AID, azathioprine exposure was associated with a 7-fold risk for myeloid neoplasm. The control and case cohorts had similar systemic exposures by agent category. No association was found for anti-tumor necrosis factor agents. Finally, no timeline was found for the association of drug exposure with the incidence in development of myeloid neoplasm.

Topics: Aged; Aged, 80 and over; Arthritis, Rheumatoid; Autoimmune Diseases; Azathioprine; Case-Control Studies; Cyclophosphamide; Female; Humans; Immunosuppressive Agents; Incidence; Leukemia, Myeloid, Acute; Lupus Erythematosus, Systemic; Male; Mercaptopurine; Methotrexate; Middle Aged; Mitoxantrone; Mycophenolic Acid; Myelodysplastic Syndromes; Odds Ratio; Psoriasis; Retrospective Studies; Risk Factors; United States

Organ transplant recipients may have skin diseases as a result of immunosuppression, but psoriasis is reported infrequently. This skin condition may be induced by immunosuppression imbalance. We present 2 cases of recurrent psoriasis in 2 kidney transplant patients with belatacept-based immunosuppressive regimens. Two years after transplant, upon suspicion of calcineurin inhibitor neurotoxicity in the first patient, tacrolimus was replaced with belatacept. The patient's neurological signs resolved but the patient presented with skin lesions compatible with psoriatic plaques, successfully treated with betamethasone dipropionate and hydrocortisone. The second patient had a history of obesity and dyslipidemia, left foot amputation, and psoriasis. He received a kidney transplant, and maintenance immunosuppression included prednisone, mycophenolate mofetil, and belatacept. At posttransplant month 15, the patient presented with cutaneous erythematosus, maculopapular, and desquamative lesions compatible with psoriasis, treated with betamethasone dipropionate. The belatacept-based immunosuppressive regimens were maintained and psoriasis resolved. Psoriasis is a potential complication in kidney recipients that may recur when belatacept is used and/or tacrolimus is withdrawn as it could have happened in the first patient. The characteristics of the second case may suggest that belatacept might not have been the inciting agent. Good results were obtained with topical treatment.

Topics: Abatacept; Graft Rejection; Humans; Immunosuppressive Agents; Kidney Transplantation; Maintenance Chemotherapy; Male; Middle Aged; Mycophenolic Acid; Prednisone; Psoriasis; Recurrence

Palmoplantar psoriasis is a chronic debilitating type of psoriasis. Treatment options for this disease are poorly studied. This chart review evaluated the use of methotrexate alone and in combination with 7 other systemic therapies in 48 patients with palmoplantar psoriasis. The findings demonstrate that methotrexate is a relatively well-tolerated and effective treatment for palmoplantar psoriasis, amenable as either monotherapy or in combination with other systemic agents.

Topics: Adalimumab; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Cyclosporine; Dermatologic Agents; Drug Therapy, Combination; Etanercept; Female; Foot Dermatoses; Hand Dermatoses; Humans; Immunosuppressive Agents; Infliximab; Male; Methotrexate; Middle Aged; Mycophenolic Acid; Psoriasis; Severity of Illness Index; Thalidomide; Ustekinumab; Young Adult

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.. To investigate the efficacy and the tolerability/short-term safety of EC-MPS in patients with moderate to severe chronic plaque psoriasis.. 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%.. 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.. 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.

Topics: Adult; Aged; Diarrhea; Drug Administration Schedule; Female; Humans; Hypertriglyceridemia; Immunosuppressive Agents; Male; Middle Aged; Mycophenolic Acid; Pilot Projects; Pruritus; Psoriasis; Tablets, Enteric-Coated; Treatment Outcome

Topics: Humans; Immunosuppressive Agents; Male; Middle Aged; Mycophenolic Acid; Psoriasis

Juvenile dermatomyositis (JDM) and psoriasis are inflammatory disorders that share interferon-α induced responses and dysregulation of cytokines, including tumor necrosis factor alpha. Although 13% of patients with JDM have a family history of psoriasis there is little information concerning children with JDM and psoriasis.. We identified 3 children with both JDM and psoriasis. In 2 cases, psoriatic lesions occurred after the child's JDM symptoms had diminished following effective immunosuppressive therapy (high-dose intermittent intravenous methylprednisolone, methotrexate, and low dose oral corticosteroids). Patient 2, initially diagnosed as having psoriasis, was treated with prednisone and methotrexate but then developed classic JDM, which worsened following use of tumor necrosis factor alpha inhibitor and reduction of prednisone and methotrexate dosage. For each child, their history of JDM complicated the choice of therapy for psoriasis.. Two therapies commonly used to treat psoriasis-phototherapy and tumor necrosis factor-alpha antagonists-must be used with caution in patients with both JDM and psoriasis owing to their potential to exacerbate clinical manifestations of JDM. We discuss the implications affecting treatment of children with these dual diagnoses and consider the pathophysiology linking these 2 conditions.

Topics: Adolescent; Child; Child, Preschool; Cyclosporine; Dermatologic Agents; Dermatomyositis; Drug Therapy, Combination; Etanercept; Female; Humans; Immunoglobulin G; Methotrexate; Methylprednisolone; Mycophenolic Acid; Phototherapy; Prednisone; Psoriasis; Receptors, Tumor Necrosis Factor; Treatment Outcome; Tumor Necrosis Factor-alpha

Topics: Adalimumab; Adrenal Cortex Hormones; Adult; Alefacept; Anti-Inflammatory Agents; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Arthritis, Rheumatoid; Crohn Disease; Cyclosporine; Etanercept; Female; Humans; Immunoglobulin G; Methotrexate; Middle Aged; Mycophenolic Acid; Psoriasis; PUVA Therapy; Receptors, Tumor Necrosis Factor; Recombinant Fusion Proteins; Treatment Outcome; Ustekinumab

A case of psoriasis and psoriatic arthritis in a 38-year-old white male patient infected with human immunodeficiency virus (HIV) treated safely and effectively with mycophenolate mofetil (MMF) is reported. Treatments for psoriasis and psoriatic arthritis are manifold, including topical, oral, intramuscular, intravenous, and subcutaneous therapies. These indicated treatments for psoriasis and psoriatic arthritis result in suppression of the immune system.

Topics: Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Antiretroviral Therapy, Highly Active; Arthritis, Psoriatic; Clobetasol; HIV Infections; Humans; Male; Middle Aged; Mycophenolic Acid; Psoriasis; Skin

Topics: Dermatologic Agents; Humans; Lupus Erythematosus, Systemic; Mycophenolic Acid; Psoriasis; Risk Factors; Skin Diseases

Mycophenolate mofetil (MMF) has been shown to be effective for systemic treatment of psoriasis. MMF is the prodrug of mycophenolic acid (MPA), the pharmacologically active compound. The measurement of plasma MPA levels could be useful for optimizing therapeutic management using MMF.. To investigate whether plasma trough levels of MPA correlate with the efficacy and safety of oral MMF in the treatment of patients with psoriasis.. Six patients (four women and two men, mean age 58 years) with severe chronic plaque-type psoriasis were treated with oral MMF 1 g twice daily. The Psoriasis Area and Severity Index (PASI), routine laboratory examinations and plasma MPA trough levels, measured by an enzyme-multiplied immunoassay (EMIT), were determined at 2 weeks and 1, 3, 5 and 7 months.. All the patients experienced a marked improvement within the first 15 days and continued to do so for 5-7 months. Two patients achieved complete remission. MMF was well tolerated. MPA levels showed a wide intra- and interindividual variability. There was no significant correlation between MPA trough levels and the reduction of the PASI or the presence of adverse effects, but a good correlation with therapeutic compliance.. The monitoring of MPA trough levels with EMIT appears to be a poor predictor of efficacy or toxicity. In contrast, it is a useful tool to evaluate the degree of therapeutic compliance.

Topics: Adult; Aged; Chronic Disease; Dermatologic Agents; Drug Monitoring; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Male; Middle Aged; Mycophenolic Acid; Patient Compliance; Prodrugs; Psoriasis; Severity of Illness Index; Treatment Outcome

Topics: Administration, Cutaneous; Humans; Immunosuppressive Agents; Mycophenolic Acid; Prodrugs; Psoriasis

The use of combination oral therapies in the management of severe psoriasis is gaining increasing acceptance. We report the concurrent use of mycophenolate mofetil (MMF) (maximum dose 3.0 g daily) with low-dose cyclosporin (mean dose 2.5 mg/kg/day) in nine patients with severe psoriasis. All had previously failed on other systemic therapies. They were all initially on treatment with cyclosporin alone which had either failed to clear their psoriasis or they were unable to tolerate higher doses. After the addition of MMF there was good clinical improvement in three patients and moderate disease control in a further four patients after a follow-up period of 3-11 months, with no additional evidence of toxicity at the doses used. We believe that MMF may be useful in some psoriatic patients unresponsive to or intolerant of other treatments or who are at risk of developing nephrotoxicity at higher doses of cyclosporin.

Topics: Administration, Oral; Adolescent; Adult; Chronic Disease; Cyclosporine; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Male; Mycophenolic Acid; Psoriasis; Treatment Outcome

Mycophenolate mofetil (MMF), a widely used immunosuppressant in organ transplantation, is a recent addition to the therapeutic armamentarium of autoimmune and inflammatory skin disorders in dermatology. We describe 5 patients with moderate to severe chronic plaque psoriasis and 6 patients with psoriatic arthritis that was refractory to conventional systemic and/or topical antipsoriatic treatment who were treated with MMF monotherapy (2 g/d) in a 10-week study. Although MMF was tolerated well in all patients, only patients with moderate psoriasis and psoriatic arthritis improved with therapy, whereas patients with severe psoriasis did not respond to MMF. Although MMF seems to be effective and safe for blistering autoimmune diseases and pyoderma gangrenosum, our data do not allow optimistic statements on the use of MMF in severe plaque-stage psoriasis. However, MMF may develop into an interesting therapeutic alternative for patients with psoriatic arthritis.

Topics: Adult; Arthritis, Psoriatic; Chronic Disease; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Mycophenolic Acid; Psoriasis

Eight patients whose severe psoriasis was treated with long-term cyclosporin (range 2-11 years; mean 7.6 years) were changed to mycophenolate mofetil (MMF), because of nephrotoxicity in seven and hypertension and lack of efficacy in one. In five patients psoriasis control significantly deteriorated and in three patients disease control deteriorated slightly in periods ranging from 2 to 32 weeks. Renal function improved in all six patients with cyclosporin-induced nephrotoxicity treated with MMF for more than 2 weeks. From this data it would appear that MMF is not as effective as cyclosporin in controlling severe psoriasis. However, MMF did offer reasonable disease control in three of eight patients and allowed renal function to improve, and so may have a place in the treatment of some patients unable to take cyclosporin because of renal toxicity.

Topics: Aged; Cyclosporine; Female; Humans; Immunosuppressive Agents; Kidney Diseases; Male; Middle Aged; Mycophenolic Acid; Psoriasis; Severity of Illness Index; Treatment Outcome

Mycophenolate mofetil (MMF) has been widely used as an immunosuppressant in organ transplantation. MMF has recently been added to therapeutic regimens for skin disorders. Expanding the use of MMF in dermatology, we describe additional patients with autoimmune and inflammatory skin diseases, including 4 cases of pemphigus vulgaris, 1 case of pemphigus foliaceus, 1 case of perineal and metastatic cutaneous Crohn's disease, 1 case of bullous pemphigoid and psoriasis, and 1 case of psoriasis. Most of these patients had refractory disease or had developed significant side effects to conventional therapy, including azathioprine, methotrexate, prednisone, cyclosporine, acitretin, PUVA, UVB, and tacrolimus. MMF was effective and well tolerated in all these patients. The dosages of MMF ranged from 500 mg twice daily (for psoriasis and Crohn's disease) to 1250mg twice daily (for 3 of 4 patients with pemphigus vulgaris). MMF is an effective and relatively safe immunosuppressant in autoimmune and inflammatory skin diseases.

Topics: Adult; Aged; Autoimmune Diseases; Crohn Disease; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Mycophenolic Acid; Pemphigoid, Bullous; Pemphigus; Psoriasis; Skin Diseases

A woman with a long history of widespread plaque psoriasis unresponsive to and/or intolerant of phototherapy, retinoids, methotrexate and cyclosporin was successfully treated with mycophenolate mofetil. Remission was maintained on doses between 1 and 1.5 g/day for 18 months without adverse effects.

Topics: Adult; Arthritis, Psoriatic; Female; Humans; Immunosuppressive Agents; Indomethacin; Mycophenolic Acid; Piroxicam; Prednisone; Psoriasis; Treatment Outcome

Mycophenolate mofetil (MMF) is a new immunosuppressive drug which non-competitively and reversibly blocks the de novo synthesis of guanine nucleotides required for DNA and RNA synthesis during T- and B-cell proliferation. This induces a selective inhibition of lymphocyte proliferation. Thus MMF is currently used to prolong graft survival in renal transplant patients. In this communication we describe the first case of a man with severe psoriasis treated successfully with oral MMF without short-term side-effects. The psoriasis area and severity index score decreased during therapy (5 weeks) from 22.0 to 11.4. Thus MMF appears to be an effective therapeutic alternative in the treatment of severe psoriasis.

Topics: Aged; Follow-Up Studies; Humans; Immunosuppressive Agents; Male; Mycophenolic Acid; Psoriasis

Topics: Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Mycophenolic Acid; Psoriasis; Time Factors; Treatment Outcome

Topics: Humans; Immunosuppressive Agents; Mycophenolic Acid; Psoriasis

In previous studies of up to 2 years' duration, mycophenolic acid has been shown to be an effective psoriasis suppressant. As the result of questions raised regarding the possible immunosuppressive and carcinogenic potentials of the drug, in addition to its apparent acute gastrointestinal side effects, widespread clinical trials were discontinued in 1977. We were given the unique opportunity of continuing to administer the drug on a compassionate-use basis to 85 patients for up to 13 years. In this review we report continued efficacy without dose escalation. Gastrointestinal side effects, prominent in the early years of the study, became infrequent. Although 11.6% of the patients developed uncomplicated zoster, no clinical evidence of immunosuppression was noted. The seven malignant neoplasms that arose in six of the patients were not unusual considering the age of the study population. Six patients died of conditions believed to be unrelated to drug therapy. We continue to believe that mycophenolic acid is an effective drug for the treatment of moderate to severe psoriasis and that the risks of its long-term administration are acceptable. With appropriate clinical and laboratory monitoring it can be given safely to patients who cannot take methotrexate and who may not be candidates for PUVA, retinoids, or other systemic chemotherapy.

Topics: Adult; Aged; Arthritis; Capsules; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged; Mycophenolic Acid; Neoplasms; Psoriasis

Eight known antipsoriatic drugs of diverse structures were tested on the basis of their structural similarity with arachidonic acid and known inhibitors of lipoxygenase. A correlation was observed between their antipsoriatic activity and lipoxygenase inhibition suggesting that a common underlying mechanism of action might be involved.

Topics: Anthralin; Arachidonate Lipoxygenases; Etretinate; Glycine max; Lipoxygenase Inhibitors; Mycophenolic Acid; Psoriasis; Resorcinols; Salicylates; Tretinoin

Topics: Animals; Anthralin; Antimetabolites; Azauridine; Cell Division; Cells, Cultured; Cycloheximide; Cytarabine; Dactinomycin; Daunorubicin; Guinea Pigs; Hydroxyurea; Methotrexate; Mycophenolic Acid; Psoriasis; Puromycin; Skin

Topics: Antineoplastic Agents; Azauridine; Humans; Hydroxyurea; Kidney Function Tests; Liver Function Tests; Methotrexate; Mycophenolic Acid; Psoriasis

Mycophenolic acid is active against fungi, bacteria, and viruses in vitro and is active against some viruses and tumors in experimental animals. Mycophenolic acid is not effective in the treatment of cancer in man, but it is effective in treating psoriasis. In all of the various diseases MA presumably inhibits the synthesis of GMP resulting in decreased synthesis of RNA and DNA. The direct inhibition of GMP synthesis is the result of MA activity against the IMPDHase and GMP synthetase as determined in experimental tumors. The inhibition of GMP synthesis can be circumvented by the guanine salvage pathway which is controlled by PRTase activity. PRTase may be the sole factor in preventing the inhibition caused by MA in the biosynthesis of GMP (Fig. 3). However, before MA can stop GMP synthesis, MA must enter the cell. The current data show that MA is almost completely detoxified in man and circulates in the plasma as the glucuronide, MAG, Glucuronides are normally inactive forms of active drugs. Due to their bivalent and non-lipophilic nature, glucuronides do not normally cross the cell membranes. Therefore, MAG is extracellular and beta-Gase intracellular, and this prevents hydrolysis of MAG to the active MA in cancer patients.

Topics: Animals; Anthranilate Phosphoribosyltransferase; Binding Sites; Fatty Acid Synthases; Female; Glucuronates; Glucuronidase; IMP Dehydrogenase; Inactivation, Metabolic; Mice; Mycophenolic Acid; Neoplasms, Experimental; Psoriasis; Rats

Thirty five patients with psoriasis (plaque type 26, guttate 3, pustular 4, and erythrodermic 2) were treated with oral mycophenolic acid for a period ranging from 52 to 104 weeks. The average follow-up was 89 weeks, and the dose schedule ranged from 2,400 to 7,200 mg daily. Excellent response was noted in 20 patients, good in 13 patients, and poor in 2. The most common clinical side effects were in the gastrointestinal tract, namely, diarrhea, nausea, abdominal cramps, and soft stools. A high incidence of herpes simplex, herpes zoster, and a flu-like syndrome was noted. Laboratory abnormalities consisted of mild blood hemoglobin reduction, one case of leukopenia (3,9000 WBCs per cubic millimeter), two cases with thrombocytopenia and mild elevation of alkaline phosphatase. Mycophenolic acid appears as a promising drug for the treatment of severe psoriasis.

Topics: Adolescent; Adult; Aged; Diarrhea; Female; Humans; Male; Middle Aged; Mycophenolic Acid; Psoriasis; Virus Diseases

Topics: Administration, Topical; Adrenal Cortex Hormones; Azauridine; Depression, Chemical; Ficusin; Humans; Methotrexate; Methoxsalen; Mitosis; Mycophenolic Acid; Nucleic Acids; Psoriasis; Ultraviolet Therapy

Mycophenolic acid (MPA), an inhibitor of purine synthesis, was evaluated for its therapeutic and adverse effects in 29 patients with psoriasis. MPA was administered orally for at least 12 weeks, during which time the daily dose was increased from 1600 to 4800 mg depending on occurrence of adverse reactions. Complete clearing occurred in 1 of the patients, almost complete clearing in 14, definite improvement in 13, slight or doubtful improvement in 1. The full effect of MPA required a median time of 8 weeks (range 5-14). After discontinuing MPA, relapses began at a median time of 4 weeks (range 3-8). The severity of psoriasis was scored on a 0 to 108 scale using a newly devised system. The mean severity and range before treatment was 47 (21-88); after 12 weeks, 15 (0-50). Adjustment of dose on the basis of side effects resulted in a median daily dose of 3600 mg (range 2400-4800 mg; 30-96 mg/kg ideal weight). Characteristic dose-limiting side effects were soft or frequent bowel movements, diarrhea, nausea, and anorexia. One instance of reversible, dose-related leukopenia was identified.

Topics: Administration, Oral; Adult; Aged; Female; Humans; Male; Middle Aged; Mycophenolic Acid; Psoriasis