Mycophenolate Mofetil for the Management of Autoimmune Bullous Diseases

Eskin‐Schwartz, Marina; Mimouni, Daniel

doi:10.1007/978-3-662-45698-9_48

Cited by 7 publications

(7 citation statements)

References 77 publications

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“…Although there are limited data to support the use of glucocorticoid‐sparing drugs for the treatment of BP, anti‐inflammatory and immunosuppressive agents are frequently utilized in clinical dermatology practice. Studies and case reports have demonstrated azathioprine, mycophenolate mofetil, methotrexate, tetracycline antibiotics (i.e., tetracycline, doxycycline, minocycline), dapsone, and nicotinamide to be efficacious steroid‐sparing treatments for BP . Given the potentially significant toxicity associated with azathioprine, mycophenolate mofetil, and methotrexate in already‐immunosuppressed oncologic patients, we prefer use of anti‐inflammatory glucocorticoid‐sparing agents for the treatment of checkpoint inhibitor‐induced BP.…”

Section: Discussionmentioning

confidence: 99%

A Case of Nivolumab-Induced Bullous Pemphigoid: Review of Dermatologic Toxicity Associated with Programmed Cell Death Protein-1/Programmed Death Ligand-1 Inhibitors and Recommendations for Diagnosis and Management

López

Geskin

2018

The Oncologist

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Bullous pemphigoid is an autoimmune subepidermal blistering disease characterized by the development of tense bullae and is most frequently seen in the elderly. PD‐1/PD‐L1‐induced bullous pemphigoid (BP) has emerged as a potentially serious dermatologic toxicity. This article reports a case of a 72‐year‐old woman who developed BP shortly after initiating treatment with the PD‐1 inhibitor nivolumab for metastatic non‐small cell lung cancer.

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Section: Discussionmentioning

confidence: 99%

A Case of Nivolumab-Induced Bullous Pemphigoid: Review of Dermatologic Toxicity Associated with Programmed Cell Death Protein-1/Programmed Death Ligand-1 Inhibitors and Recommendations for Diagnosis and Management

López

Geskin

2018

The Oncologist

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“…80,81 Published studies also support the clinical efficacy of these mycophenolate drugs in various inflammatory or autoimmune conditions, such as autoimmune hepatitis, myositis, bullous disease, interstitial lung disease, and lupus nephritis, among others. [82][83][84][85][86][87] Retrospective analyses and case reports describe the use of mycophenolate in the management of steroid-refractory irAEs, including those involving the liver, kidney, pancreas, and eyes. 43,[88][89][90][91] Intravenous immunoglobulin (IVIG) has been used to suppress a wide array of autoimmune and chronic inflammatory conditions.…”

Section: Immunomodulatorsmentioning

confidence: 99%

Management of Immunotherapy-Related Toxicities, Version 1.2019, NCCN Clinical Practice Guidelines in Oncology

Thompson

Schneider

Brahmer

et al. 2019

Journal of the National Comprehensive Cancer Network

455

332

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The aim of the NCCN Guidelines for Management of Immunotherapy-Related Toxicities is to provide guidance on the management of immune-related adverse events resulting from cancer immunotherapy. The NCCN Management of Immunotherapy-Related Toxicities Panel is an interdisciplinary group of representatives from NCCN Member Institutions and ASCO, consisting of medical and hematologic oncologists with expertise in a wide array of disease sites, and experts from the fields of dermatology, gastroenterology, neuro-oncology, nephrology, emergency medicine, cardiology, oncology nursing, and patient advocacy. Several panel representatives are members of the Society for Immunotherapy of Cancer (SITC). The initial version of the NCCN Guidelines was designed in general alignment with recommendations published by ASCO and SITC. The content featured in this issue is an excerpt of the recommendations for managing toxicity related to immune checkpoint blockade and a review of existing evidence. For the full version of the NCCN Guidelines, including recommendations for managing toxicities related to chimeric antigen receptor T-cell therapy, visit NCCN.org.

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“…Although like azathioprine, mycophenolate mofetil (MMF) is FDA category D, human experience suggests that the risks outweigh the benefits for MMF, but not azathioprine. MMF should be discontinued 6 weeks before becoming pregnant to avoid the known teratogenic effects . MMF is known to readily cross the placenta and exposure during embryogenesis leads to an increased rate of spontaneous abortions and congenital malformations, at reported rates ranging from 20 to 60%.…”

Section: Medications Commonly Used In Autoimmune Skin Disease That Armentioning

confidence: 99%

Treatment of dermatologic connective tissue disease and autoimmune blistering disorders in pregnancy

Braunstein

Werth

2013

Dermatol Ther

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Autoimmune skin disease occurs in pregnancy, and treatment is often required to control both maternal disease and fetal outcomes. Here we present the available safety data in pregnancy and lactation for medications used to treat autoimmune skin diseases, including cutaneous lupus erythematosus, dermatomyositis, morphea and systemic sclerosis, pemphigus vulgaris, pemphigus foliaceus, and pemphigoid gestationis. A PubMed search of the English-language literature using keywords, "pregnancy" "rheumatic disease," and "connective tissue disease" was performed. Relevant articles found in the search and references were included. Reasonable evidence supports the careful and cautious use of topical steroids, topical calcineurin inhibitors, systemic corticosteroids, hydroxychloroquine, and azathioprine in pregnancy. Case reports or clinical experience suggest intravenous immunoglobulin, dapsone, phototherapy, rituximab, and plasmapheresis may be safe. Several treatment options exist for autoimmune skin disease in pregnancy and lactation, and should be considered when treating these patients.

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Mycophenolate Mofetil for the Management of Autoimmune Bullous Diseases

Cited by 7 publications

References 77 publications

A Case of Nivolumab-Induced Bullous Pemphigoid: Review of Dermatologic Toxicity Associated with Programmed Cell Death Protein-1/Programmed Death Ligand-1 Inhibitors and Recommendations for Diagnosis and Management

A Case of Nivolumab-Induced Bullous Pemphigoid: Review of Dermatologic Toxicity Associated with Programmed Cell Death Protein-1/Programmed Death Ligand-1 Inhibitors and Recommendations for Diagnosis and Management

Management of Immunotherapy-Related Toxicities, Version 1.2019, NCCN Clinical Practice Guidelines in Oncology

Treatment of dermatologic connective tissue disease and autoimmune blistering disorders in pregnancy

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