The use of mycophenolate mofetil for the treatment of autoimmune and chronic idiopathic urticaria: Experience in 19 patients

• Published in: Journal of the American Academy of Dermatology 2012-05, Vol.66 (5), p.767-770
• Main Authors: Zimmerman, Andrew B., BA, Berger, Emily M., MD, Elmariah, Sarina B., MD, PhD, Soter, Nicholas A., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Allergic diseases; angioedema; Autoimmune Diseases - diagnosis; Autoimmune Diseases - drug therapy; autoimmune urticaria; Biological and medical sciences; Child; Chronic Disease; chronic idiopathic urticaria; Cohort Studies; Dermatology; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; hives; Humans; immunomodulators; Immunopathology; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Male; Medical sciences; Middle Aged; mycophenolate mofetil; Mycophenolic Acid - adverse effects; Mycophenolic Acid - analogs & derivatives; Mycophenolic Acid - therapeutic use; Retrospective Studies; Skin allergic diseases. Stinging insect allergies; treatment; Treatment Outcome; Urticaria - diagnosis; Urticaria - drug therapy; Urticaria - immunology; Young Adult
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2011.06.004

Background There is a paucity of investigation on which to base the treatment of chronic urticaria after a patient fails maximum therapy with antihistamines. One prospective, open-label, uncontrolled study suggested that mycophenolate mofetil may be a successful second-line therapy. Objective We sought to evaluate the efficacy and safety of mycophenolate mofetil in 19 patients with autoimmune and chronic idiopathic urticaria. Methods In a retrospective chart review, records of patients with autoimmune and chronic idiopathic urticaria who were evaluated between 2001 and 2009 were analyzed. Results Improvement in urticaria was observed in 89% of patients, specifically 91% of patients with autoimmune urticaria and 88% with chronic idiopathic urticaria. Time to initial improvement ranged from 1 to 9 weeks. In 59% of these patients, complete control of urticaria was achieved, which included 70% of patients with autoimmune urticaria and 43% with chronic idiopathic urticaria. Mean time to complete control was 14 weeks, with a range of less than 1 to 31 weeks. The dose of mycophenolate mofetil at complete control ranged from 1000 to 6000 mg divided twice daily. Mycophenolate mofetil was tapered in 7 of these 10 patients after an average of 7 weeks. Six of the 7 patients tapered then discontinued mycophenolate mofetil with remissions lasting between 2 and 16 weeks up to when the chart review ended. Mycophenolate mofetil was well tolerated with no serious infections or laboratory abnormalities. Gastrointestinal symptoms were most common. Limitations This was a retrospective chart analysis. The number of patients was relatively small. Conclusions Mycophenolate mofetil is a useful and well-tolerated second-line therapy for patients with autoimmune and chronic idiopathic urticaria in whom antihistamines and other therapeutic agents have failed.