Mycophenolate mofetil (MMF) (CellCept) is a purine synthesis inhibitor that is hydrolysed to mycophenolic acid, a potent inhibitor of inosine monophosphate dehy-drogenase required for purine synthesis in B and T lymphocytes as well as the inhibition of adhesion molecule glycosylation and the activation of monocytes (Frieling and Luger 2002, Kitchin et al. 1997). MMF therapy has been proved to be effective for the prevention of organ transplant rejection and for the therapy of rheumatoid arthritis and Crohn's disease. In addition, skin diseases such as bullous pemphigoid, pemphigus, psoriasis, and atopic dermatitis have been shown to significantly improve with MMF treatment (Beissert and Luger 1999, Geilen et al. 2000). In some case reports, MMF also was found to improve SLE, particularly lupus nephritis (Chan et al. 2000, Gaubitz et al. 1999). Moreover, treatment of diffuse proliferative lupus nephritis with MMF and prednisolone compared with cyclophosphamide and pred-nisolone was equally effective but remarkably less toxic (Chan et al. 2000). MMF also seems to be a successful approach to treat therapy-resistant skin lesions of SCLE (Schanz et al. 2002). Accordingly, two patients with extended SCLE that did not respond to administration of azathioprine and antimalarials or high-dose cortico-steroids were treated with MMF, 2g daily. Within a few weeks, the skin lesion improved and finally disappeared. There is evidence that a daily dose of 1 g may be sufficient to maintain remission, whereas 500 mg daily in one case was followed by the recurrence of the skin lesions. One patient received MMF for more than 24 months without reporting significant side effects. Furthermore, two cases of refractory DLE involving the palms and soles have been reported to be successfully treated with MMF (Goyal and Nousari 2001). Patients received 45 mg or 35mg/kg daily, and within 4 months marked improvement of the skin lesion was documented. No side effects were reported, and the results of routine laboratory investigations remained within normal limits. These data indicate that MMF seems to be an effective and safe treatment for SLE as well as CLE. However, further controlled clinical trials are required to ultimately establish the role of MMF in LE therapy.
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