Mycophenolate mofetil as a systemic antipsoriatic agent: positive experience in 11 patients

BACKGROUND: Mycophenolate mofetil (MMF) is a novel immunosuppressive drug. Several case reports have suggested that MMF has a beneficial effect in patients with psoriasis and autoimmune dermatoses. OBJECTIVES: To investigate the efficacy and safety of oral MMF in severe psoriasis. METHODS: Eleven patients with severe stable plaque-type psoriasis and a Psoriasis Area and Severity Index (PASI) between 12 and 53 (mean 30.5) were included in the study. They received oral MMF 1 g twice daily for 3 weeks and then 0.5 g twice daily for 3 weeks. The PASI were determined at baseline (week 0) and after 1, 2, 3 and 6 weeks of treatment. RESULTS: Within 3 weeks of this therapy there was a reduction in PASI of between 40% and 70% in seven of 11 patients, and only one patient achieved a reduction in PASI of < 25% from baseline (mean PASI 15.6). Reducing MMF from 2 g daily to 1 g daily led to further, although only slight, improvement in six of 11 patients during the following 3 weeks. In four of 11 patients, the PASI increased at this lower dosage, and in one patient the drug was withdrawn because of muscle pain, which was possibly drug induced. This side-effect reversed within a few days after stopping the drug. Other side-effects, especially gastrointestinal and haematological toxicity, were not observed in any of the 11 patients treated. Overall, the mean PASI was 16.1 after 6 weeks. CONCLUSIONS: We conclude that the immunosuppressant MMF 2 g daily is effective and safe in the treatment of severe psoriasis.