Mycophenolate mofetil as an effective corticosteroid-sparing therapy for recalcitrant dermatomyositis.
BACKGROUND
Dermatomyositis (DM) is a multisystem idiopathic inflammatory disorder that most commonly affects the muscles and skin. Systemic corticosteroids are the mainstay of therapy but are limited by their long-term adverse effects.


METHODS
We sought to evaluate the effectiveness of oral mycophenolate mofetil in patients with cutaneous lesions of DM recalcitrant to other therapies through an open-label retrospective medical chart review of patients in a university-affiliated private practice setting. Twelve patients with DM who had skin lesions recalcitrant to traditional therapies or who developed toxic effects from traditional therapies began mycophenolate mofetil treatment at doses ranging from 500 mg to 1 g twice a day. Response was based on improvement in skin disease as judged clinically, an increase in strength, and/or an ability to decrease or discontinue concomitant therapies. Improvement was seen in 10 of the 12 patients, most within 4 to 8 weeks. Most patients tolerated mycophenolate mofetil treatment without problem; however, 1 patient developed a B-cell lymphoma of the central nervous system, and another developed abnormal levels of hepatic enzymes along with urinary symptoms. Resolution of these toxic reactions occurred with cessation of mycophenolate mofetil treatment in each patient.


CONCLUSIONS
Mycophenolate mofetil may be an effective corticosteroid-sparing therapy for the treatment of some patients with DM.
Edge
Johnathon C
JC
Division of Dermatology, Department of Medicine, University of Louisville School of Medicine, KY, USA.
Outland
J David
JD
Dempsey
Jennifer R
JR
Callen
Jeffrey P
JP
D000328:Adult; D003882:Dermatomyositis / Q000188:drug therapy*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010257:Paraneoplastic Syndromes / Q000188:drug therapy; D011355:Prodrugs / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011355:Prodrugs; D009173:Mycophenolic Acid