Mycophenolate Mofetil
A Transplant Rejection Drug Used In The Treatment of Autoimmune Diseases
An immunosuppressant that has decreased the incidence of acute rejection in solid transplant recipients, mycophenolate is increasingly utilized as a steroid sparing treatment in autoimmune diseases and similar immune-mediated disorders including Behçet's disease, pemphigus vulgaris, refractory incomplete systemic lupus erythematosus,[7] immunoglobulin A nephropathy, small vessel vasculitides, and psoriasis.[8]
Its increasing application in treating lupus nephritis has demonstrated more frequent complete response and less frequent complications[8] compared to cyclophosphamide bolus therapy, a regimen with risk of bone marrow suppression, infertility, and malignancy.[9] Further work addressing maintenance therapy demonstrated mycophenolate superior to cyclophosphamide, again in terms of response and side-effects.[9] Walsh et al. even propose that mycophenolate should be considered as a first-line induction therapy for treatment of lupus nephritis in patients without renal dysfunction.[10]
Mycophenolate mofetil is beginning to be used in the management of auto-immune disorders such as idiopathic thrombocytopenic purpura (ITP), systemic lupus erythematosus (SLE), scleroderma (systemic sclerosis or SSc), andpemphigus vulgaris (PV) with success for some patients.[13]
It is also currently being used as a long-term therapy for maintaining remission of granulomatosis with polyangiitis, though thus far, studies have found it inferior to azathioprine. A combination of mycophenolate andribavirin has been found to stop infection by and replication of dengue virus in vitro.
Takayasu arteritis, ANCA-associated vasculitides and all medium vessel vasculitic conditions do respond to it. However, due to its slow onset of action, initial aggressive disease may be managed with high dose steroids and other immunosuppressants. Maintenance of remission is much better with mycophenolate, especially due to lower infection rate with this agent. After persistent remission, dose can be reduced to 1000 mg per day, but not lower as relapses more common in doses lower than this
Side Effects
Effect of sunlight
Mycophenolate mofetil tablets reduce your body’s defences. As a result, there is an increased risk of skin cancer. Limit the amount of sunlight and UV light you get. Do this by:
- wearing protective clothing which also covers your head, neck, arms and legs
- using a sunscreen with a high protection factor.
Fighting infections
Mycophenolate mofetil tablets reduce your body’s defences. This is to stop you rejecting your transplant. As a result, your body will not be as good as normal at fighting infections. This means you may catch more infections than usual. This includes infections of the brain, skin, mouth, stomach and gut, lungs and urinary system.
Lymph and skin cancer
As can happen in patients taking this type of medicine (immunosuppressants), a very small number of Mycophenolate mofetil patients have developed cancer of the lymphoid tissues and skin.
General unwanted effects
You may get general side effects affecting your body as a whole. These include serious allergic reactions (such as anaphylaxis, angioeodema), fever, feeling very tired, difficulty sleeping, pains (such as stomach, chest, joint or muscle, pain on passing urine), headache, flu symptoms and swelling.
Nervous system problems such as:
- feeling dizzy, drowsy or numb
- tremor, muscle spasms, convulsions
- feeling anxious or depressed, changes in your mood or thought
