Lupus and cellcept
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Mycophenolate mofetil (CellCept) is a drug often used to treat lupus.
This immunosuppressant shows moderate effectiveness for complications in the kidney and seems to cause less infection and diarrhea than other agents.
Studies in 2003 and 2004 have shown that in patients with severe lupus nephritis, CellCept is as effective as daily cyclophosphamide and superior to monthly cyclphosphamide therapy. Patients may receive CellCept as an initial treatment, or may be given it once remission has been achieved by another drug first. One particularly effective approach entails initial treatment with cyclophosphamide followed by maintenance with CellCept.
The drug CellCept works in controlling lupus symptoms, yet with few short-term side effects.
CellCept is approved for preventing organ transplant rejection and is known to work for patients who have kidney damage from lupus.
However, it holds great promise in relieving lupus symptoms for patients without kidney problems.
Lupus is a disease caused by immune system dysregulation that causes fevers, joint pain, excessive fatigue, and in severe cases, major organ damage, especially to the kidneys. There is no cure for lupus.
Like many lupus drugs that work by suppressing the immune system, CellCept increases the risk of infection and the possible development of lymphoma, a cancer of the lymph nodes.
A group of researchers at the Mayo Clinic performed a six-month study involving 17 patients with lupus. At the study's end, 11 patients had a significant improvement in lupus symptoms, four had a partial improvement in lupus symptoms, and two had no improvement in lupus symptoms, reports lead researcher Kevin G. Moder, MD, a rheumatologist with the Mayo Clinic.
Those who responded with an improvement in lupus symptoms were also able to decrease their dose of prednisone, an immune-suppressing drug commonly used to treat lupus symptoms.
Three patients withdrew from the study because of side effects from CellCept, one with a rash and two with nausea.
Moder presented his findings at the American College of Rheumatology Annual Scientific Meeting in San Antonio.
"This would be considered a nice addition to medications we can use for these patients -- an alternative and widely applicable to many patients," says Moder in a news release. "It's a significant step if the medication is effective but has fewer side effects" than current medications for lupus symptoms.
Organ rejection is an immune reaction with many parallels to autoimmune disease. CellCept’s unique mode of action and positive efficacy and safety data in the transplant market suggest it could also benefit many autoimmune disease patients.
For several years physicians have been increasingly interested in investigating the use of CellCept in a variety of autoimmune diseases. Some of the most promising results so far have been seen in lupus (a disease causing chronic skin rash and affecting other body systems), myasthenia gravis (a disorder characterized by weakening of the muscles and fatigue, notably affecting the muscles of the mouth and throat), pemphigus vulgaris (a skin disease characterized by blisters that heal poorly) and autoimmune hepatitis.
CellCept was first approved in 1995 for renal transplant, and the indications for CellCept now also include heart, liver and pediatric kidney transplants.
Corticosteroids are still the mainstay of treatment for many autoimmune diseases and physicians have to constantly balance the requirement for best possible disease control with the drug related morbidities associated with long term steroid exposure. For example, no treatments have been approved for lupus in over for 30 years, and the current standard of care, the cancer drug cyclophosphamide, is associated with significant drug related morbidity.
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