Whereas the drugs described so far functionally or physically influence immune cells involved in the pathogenesis of LE, mycophenolate mofetil (MMF) and leflunomide were shown to decrease T- and B-cell proliferation by interfering with purine and pyrimidine metabolism, respectively. Whereas MMF is well established within transplantation medicine, leflunomide is licensed for use in rheumatoid arthritis. Both drugs have been used outside these indications in the context of LE (Furst 1999, Jayne 1999, Kurtz et al. 1995). MMF was shown to be effective for DLE and SCLE at doses of
2g/d (Boehm and Bieber 2001, Goyal and Noussari 2001,Hanjani and Noussari 2002, Karim and Alba 2002, Schanz et al. 2002), whereas leflunomide was shown to positively influence accompanying cutaneous symptoms when applied for arthritic symptoms within SCLE as the main therapeutic target (10-20 mg/d) (Glant et al. 1998, Parnham 1995, Remer and Weisman 2001). However, gastrointestinal side effects, mainly diarrhea for MMF and hematologic and hepatic disturbances for leflunomide, may be limiting clinical application.
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