Mycophenolate Mofetil as Therapy for Pyoderma Gangrenosum

Abstract

Background: Pyoderma gangrenosum is an ulcerative condition that may be associated with inflammatory bowel disease or inflammatory arthritis. In addition to local wound care, management often includes the use of systemic corticosteroids or systemically administered immunomodulatory agents. Observations: We retrospectively analyzed 7 patients with pyoderma gangrenosum who were treated with mycophenolate mofetil. Patients were included if they had a diagnosis of pyoderma gangrenosum and were treated with mycophenolate mofetil for at least 2 uninterrupted months. Improvement was based on reduction in lesion size or decrease in concomitant therapy. Overall, 6 of 7 patients had some reduction in ulcer size while receiving mycophenolate mofetil therapy, and 4 of 7 completely healed. However, responsiveness was inadequate in 3 patients. Two discontinued mycophenolate mofetil for alternate therapy, and the third required the addition of dapsone and infliximab for complete healing. The only adverse event observed in our analysis attributed to mycophenolate mofetil therapy was transient anemia. Conclusions: Mycophenolate mofetil may be beneficial as an immunomodulatory agent in selected patients with pyoderma gangrenosum. Further controlled trials are warranted to define its place among the therapeutic options for this rare disease.

Treatment of pyoderma gangrenosum with mycophenolate mofetil as a steroid-sparing agent

“…This is consistent with the upper limit of previously reported response rates of 57% to 86%. Our patients responded to doses ranging from 1 to 3 g total daily, and previous reports have described doses from 1 to 4 g total daily, 1,[9][10][11][12] suggesting that requirements vary substantially. The 4 patients in our series who showed no clear response received 1, 2, 4, and 12 months of MMF, respectively.…”

“…13 In the PG literature, MMF has been used alone, together with prednisolone and in combination with other steroid-sparing agents. 1,9,10 In our series, many patients had combination therapy, generally with cyclosporine. Seven patients took a single additional steroid-sparing agent, 6 patients took 2, and 2 patients required a cocktail of 3 or more additional agents, reinforcing again the need for individualized treatment regimens.…”

Pioderma Gangrenoso: apresentação clínica de difícil diagnóstico

“…Cyclosporin, azathioprine, dapsone, clofazimine, thalidomide and mofetil mycophenolate have also been used. 9 Recently, infliximab was used as an alternative treatment for PG. 10 In 2004, Su et al 11 proposed a set of primary and secondary diagnostic criteria for PG.…”

Oral ulceration in pyoderma gangrenosum

“…A retrospective review of MMF in PG showed over half of patients gain complete ulcer resolution. 1 Pyoderma gangrenosum with oral involvement is rare. There have been a handful of case reports in the literature linking oral PG with inflammatory bowel disease and hematological disorders.…”