Progress in understanding the pathogenesis and treatment of rheumatologic and glomerular diseases such as systemic lupus erythematosus and particularly lupus nephritis has been closely linked with the development of newer immunosuppressive agents. With improved patient survival following the institution of cyclophosphamide and corticosteroid therapy, longer-term management issues came to the forefront, especially how to decrease adverse effects of the immunosuppressive regimen. Many of the immunosuppressive regimens used in lupus patients were first established as efficacious and safe through their use in solid organ transplantation. Mycophenolate mofetil (MMF) is now widely used in the field of transplantation. Following anecdotal reports describing benefits of MMF in lupus and lupus nephritis patients, small studies and finally large randomized, controlled trials have established the use of MMF in these patients, particularly those with lupus nephritis. MMF use in other rheumatologic and renal diseases has been evaluated in only smaller studies and very few randomized controlled trials. Nevertheless, many studies currently are ongoing with this immunosuppressive agent. This article will review the published data and the experience of two major New York medical centers with the use of MMF in autoimmune and renal diseases.
"Mycophenolate mofetil (MMF), an inhibitor of lymphocytes proliferation through blockade of inosine monophosphate dehydrogenase and interference with purine biosynthesis , is commonly used to prevent rejection following solidorgan transplantation     . Its clinical utility has been expanded for the treatment of several autoimmune and renal disorders . MMF languished in relative obscurity until the past 5 years when it emerged to function not only as an anti-inflammatory but also as an antiproliferative agent by downregulating the expression of several critical growth factors including transforming growth factor-(TGF-) β. "
[Show abstract][Hide abstract] ABSTRACT: Background. Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic interstitial lung disease with ineffective treatment. Mycophenolate mofetil (MMF) is an immunomodulatory agent which inhibits lymphocyte proliferation. Objective. We sought to determine the safety and efficacy profile of MMF in IPF patients. Methods. We retrospectively identified ten patients, who met the ATS/ERS 2000 criteria for IPF and received MMF 2 gr/day for 12 months. All of them had routine laboratory, pulmonary function and radiological (high resolution computed tomography-HRCT) data available and were enrolled in the study. Forced vital capacity (FVC), total lung capacity (TLC), diffusion capacity of the lung for carbon monoxide (DL(CO)), 6-minute walking distance (6MWD), HRCT scans and routine laboratory data at treatment onset were compared with respective values 12 months after treatment onset. Results. There were no significant alterations in FVC, TLC, DL(CO) and 6MWD pre- and 6 and 12 months post-treatment. HRCT evaluation showed deterioration of the total extent of disease (P = 0.002) and extent of ground-glass opacity (P = 0.02). No cases of clinically significant infection, leucopenia, or elevated liver enzymes were recorded. Conclusions. MMF is a safe therapeutic modality which failed to show a beneficial effect both in functional and radiological parameters in a small cohort of IPF patients.
Pulmonary Medicine 05/2011; 2011(2, part 1):849035. DOI:10.1155/2011/849035
"Mycophenolate mofetil has been used since the 1990s as an immunosuppressive drug for the prevention of rejection in kidney transplantation. Due to favourable experience, with fewer adverse effects, it is currently used in liver, lung, and bone marrow transplantation and in the treatment of several autoimmune diseases, such as systemic lupus erythematosus, systemic vasculitis [7, 8] and some primary glomerular diseases [7, 9]. It suppresses the immune response by inhibiting activated lymphocytes, blocks purine synthesis, and inhibits specific proliferative responses of both T and B cells to antigens [8, 10]. "
[Show abstract][Hide abstract] ABSTRACT: Goodpasture's disease is a rare autoimmune disorder characterised by the development of antiglomerular basement membrane autoantibodies, which typically presents with rapidly progressive crescentic glomerulonephritis and pulmonary haemorrhage. Even with aggressive nonspecific immunosuppression and plasma exchange, mortality remains high.
We report a case of life-threatening Goodpasture's disease with relapsing pulmonary haemorrhage refractory to conventional therapy. Second line treatment was based on mycophenolate mofetil 1 g every 12 hours and prednisolone 60 mg/day. In this case, the use of a low-dose mycophenolate mofetil regimen turned out to be insufficient. However, in our opinion higher mycophenolate mofetil doses should be considered an alternative treatment, mainly in relapsing disease, due to its mechanism of action and current insufficient therapeutic weapons.
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