First experience with enteric-coated mycophenolate sodium (Myfortic) in severe recalcitrant adult atopic dermatitis: an open label study.
BACKGROUND
Severe atopic dermatitis (AD) is often treated successfully with oral immunosuppressive drugs such as cyclosporin (CsA) or oral corticosteroids. However, some patients develop adverse effects or are unresponsive to these first-choice oral immunosuppressive drugs.


OBJECTIVE
To evaluate whether enteric-coated mycophenolate sodium (EC-MPS) is an effective treatment in patients with severe, recalcitrant AD.


METHODS
Ten patients with severe, recalcitrant AD were treated with EC-MPS 720 mg twice daily for 6 months. All patients had to discontinue other oral immunosuppressive drugs due to adverse effects (n = 8) or nonresponsiveness (n = 2). Disease activity was monitored using the Severity Scoring of Atopic Dermatitis (modified SCORAD) index and the Leicester Sign Score (LSS). Additionally, the level of serum thymus and activation-regulated cytokine (TARC) was measured. During treatment, safety laboratory examination was performed. Total serum immunoglobulin E (IgE) was followed during treatment. Use of topical corticosteroids was recorded before and during treatment.


RESULTS
Compared with baseline, the mean scores for disease activity significantly decreased during treatment with EC-MPS [modified SCORAD (P = 0.04), LSS severity (P = 0.01), LSS extent (P = 0.01)]. In addition, serum TARC levels and total serum IgE levels significantly decreased after treatment compared with before (P = 0.03; P = 0.05). Disease activity decreased after approximately 2 months of treatment and stabilized during the 6-month treatment period. No differences in the amount of topical corticosteroids used in the 6 months prior to treatment compared with the 6-month treatment period were found (P = 0.4). None of the patients discontinued use of EC-MPS and only mild adverse effects were seen.


CONCLUSIONS
In this study EC-MPS at a dose of 720 mg twice daily for 6 months has proven to be an effective and well-tolerated treatment for patients with severe, recalcitrant AD.
van Velsen
S G A
SG
Department of Dermatology and Allergology, University Medical Centre Utrecht, G02.124, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. s.g.a.vanvelsen@umcutrecht.nl
Haeck
I M
IM
Bruijnzeel-Koomen
C A F M
CA
de Bruin-Weller
M S
MS
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013608:Tablets, Enteric-Coated; D016896:Treatment Outcome; D055815:Young Adult
D015415:Biomarkers; D007166:Immunosuppressive Agents; D013608:Tablets, Enteric-Coated; D007073:Immunoglobulin E; D009173:Mycophenolic Acid