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Myconphenolate mofetil

Myconphenolate mofetil is an anti-metabolite immunosuppressive developed for organ transplantation. No randomised trials have been performed in psoriasis but several reports indicate a beneficial effect. PASI decreased within 3 weeks by 40–70% in seven of 11 patients, and by 25–39% in three of 11. It appears less efficacious than ciclosporin but can be combined with low dose ciclosporin.

Usually myconphenolate is commenced at a lower dose of 250-500mg twice daily and gradually increased to 1g twice daily. In transplantation higher doses are associated with increased toxicity but no further efficacy. Response in psoriasis does not appear to be a result of pharmacokinetic effects. Once response is observed the dose can often be reduced.

Initial monitoring is with weekly FBC for one month then fortnightly for two months and monthly thereafter. Women of childbearing potential receiving mycophenolate mofetil should be advised to use effective contraception prior to, during and for six weeks following discontinuation of therapy. Patients discovered or planning to become pregnant should be referred to the specialist at the earliest opportunity.  Breastfeeding: women treated with mycolphenolate mofetil should not breastfeed.

Myconphenolate interacts with cholestyramine and antacids (reduced absorption). 50% of patients experience gastrointestinal upset, nausea, cramps, diarrhoea. Rarely perforation or haemorrhage or pancreatitis occur. Bone marrow suppression is an important adverse effect with leukopenia in 5% of patients 

References

E. Daudén, C. Sánchez-Peinado, D. Ruiz-Genao, M. García-F-Villalta, M.J. Onate, A. García-Díez. Plasma trough levels of myconphenolic acid do not correlate with efficacy and safety of myconphenolate mofetil in psoriasis. British Journal of Dermatology. Volume 150, Issue 1, Page 132-135, Jan 2004

C.C. Geilen, M. Arnold, C.E. Orfanos Myconphenolate mofetil as a systemic antipsoriatic agent: positive experience in 11 patients. British Journal of Dermatology Volume 144, Issue 3, Page 583-586, Mar 2001

This information forms part of the current BAD guidance document for the general management of psoriasis.  Other sections in the document comprise: