Mycophenolate Mofetil

Like methotrexate, mycophenolate mofetil (MMF) interferes with purine synthesis. Both drugs selectively and reversibly inhibit the enzyme inosine monophosphate dehydrogenase, which is important for guanosine and purine synthesis. With the exception of lymphocytes, most cells in the body can use salvage pathways to circumvent the inhibition of the de novo synthesis of purine. Since T and B cells depend exclusively on the de novo synthesis pathway, MTX and MMF impede cell growth and proliferation, resulting in a reduced activation status [36], decreased responses to antigenic stimulation and reduced antibody production.

The typical dose of MMF is 1,000 mg orally twice a day. Side effects include nausea and GI tract discomfort especially during the first weeks of therapy. This can be reduced if a low dose is given initially and increased to the final dose within 2-4 weeks. Leucopenia, renal and liver toxicity are rare, but appropriate monitoring should be installed.

Patients with all types of uveitis have been treated with MMF, either as a steroid-sparing agent or as a rescue therapy in otherwise non-responsive inflammation. Downmodulation of inflammation or prevention of relapses was reported in eight of ten patients [82]. In a recent study, control of ocular inflammation with MMF as monotherapy was achieved in 65% of patients, and a steroid-sparing effect in 54% of patients [5]. In both studies, MMF was considered safe. The concomitant application of MMF with cyclosporine promises additive effects, since both inhibit T cells, although the modes of action of the two drugs are different. Therefore, the combination therapy of MMF with other immunosuppressive regimens, predominantly with cyclosporine, led to a relief of symptoms and the ability to reduce the dose of prednisone in most patients. Ten of 11 patients showed a favourable response to MMF, with few side effects noted [41]. Another study supported this finding [25]. Here a marked resolution of ocular inflammatory activity occurred in 13 of 18 patients. Corticosteroids were discontinued in four patients and the steroid dose could be reduced in 14 patients following MMF therapy.

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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