Mycophenolate mofetil in the treatment of non-renal manifestations of systemic lupus erythematosus: recent insights

Abstract

Mycophenolate mofetil (MMF) is an immunosuppressive agent that has been shown to beeffective in transplant patients. It is also efficacious in the management of lupus nephritis, anduseful in the treatment of autoimmune conditions as its mechanisms of action target the T- andB – lymphocytes, leading to suppression of the cell-mediated 3immune responses and antibodyformation. It has been used successfully in immune-mediated conditions like myasthenia gravis,autoimmune hepatitis and immune cytopenias. However, its optimal use in non-renalmanifestations (hematological, neuropsychiatric, myocardial, pulmonary, cutaneous etc.) inlupus patients is unclear. There are yet to be randomised controlled trials to guide the optimaldoses and durations of MMF in such situations. MMF is well tolerated and safe to use, thoughthere are reports of serious adverse effects like urticaria, myopathy, Epstein-Barr virus-associatedB-cell lymphoma, cytomegalovirus infections and disseminated varicella zoster. Another areaof concern for patients is the increased cost of using long-term MMF

Keywords

• systemic lupus erythematosus,mycophenolate mofetil,treatment

Sistemik Lupus Eritematozus’un Böbrek Dışı Tutulumlarının Tedavisinde Mikofenolat Mofetil: Son Görüşler

Abstract

Mikofenolat mofetil (MMF) transplant hastalarında etkinliği gösterilmiş bir immünsüpresifajandır. Lupus nefriti ve diğer otoimmün hastalıkların tedavisinde; T ve B lenfositleri hedef alanetki mekanizmasına bağlı olarak, hücresel immün yanıtı ve antikor oluşumunu baskıladığıgösterilmiştir. Myastenia gravis, otoimmün hepatit, immün sitopeniler gibi otoimmünhastalıklarda başarıyla kullanılmaktadır. Fakat, lupus hastalarında böbrek dışı tutulumlarda(hematolojik, nöropsikiyatrik, miyokardiyal, pulmoner, kütanöz vb.) optimal kullanımı kesinlikkazanmamıştır. Bu durumlarda kullanımında optimal doz ve süreye dair yol gösterici randomizekontrollü çalışma henüz bulunmamaktadır. MMF iyi tolere edilmesi ve kullanımı güvenliolmasına rağmen; ürtiker, miyopati, Epstein-Barr virüs ilişkili B-hücreli lenfoma,sitomegalovirüs enfeksiyonları ve dissemine varisella zoster gibi birtakım yan etkilerbildirilmiştir. MMF’in uzun süreli kullanımında hastalar için önemli olan bir diğer noktada artanmaliyetidir

Keywords

• sistemik lupus eritematozus,mikofenolat mofetil,tedavi

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