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

https://doi.org/10.1016/j.jaad.2011.06.004Get rights and content

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.

Section snippets

Methods

After approval from the institutional review board at New York University Langone Medical Center, a retrospective chart review of 140 patients with a diagnosis of autoimmune or chronic idiopathic urticaria, who presented to our institution between 2001 and 2009, was performed. Nineteen patients treated with mycophenolate mofetil were identified (13 women, 6 men). Eleven had autoimmune urticaria and 8 had chronic idiopathic urticaria. In 14 patients, a chronic urticaria test was performed on

Results

Patients with chronic urticaria presented to our center at an average age of 45 years (median 44 years, range 12-77 years). The average age at diagnosis of urticaria and angioedema was 40 years (median 40 years, range 1-77 years).

Before initiating mycophenolate mofetil, none of the patients was controlled with multiple H1-receptor antagonists and the addition of H2-receptor antagonists in 10 of 19 patients. The majority of patients had been treated with additional alternative agents, which

Discussion

H1-antihistamines are the most frequently used agents that are used in the treatment of urticaria and angioedema and are often therapeutically successful with or without the use of additional agents, which include H2-antagonists, leukotriene inhibitors, doxepin, nifedipine, colchicine, dapsone, hydroxychloroquine, sulfasalazine, systemic glucocorticoids, methotrexate, cyclosporine, mycophenolate mofetil, omalizumab, plasmapheresis, autologous whole blood, and intravenous immunoglobulin.7, 8, 9,

Conclusion

In our experience, as outlined in this retrospective review, mycophenolate mofetil is a useful and well-tolerated second-line therapy for patients with autoimmune and chronic idiopathic urticaria who have failed therapy with antihistamines or other therapeutic agents. Of 19 patients treated with mycophenolate mofetil at our center, 17 patients experienced improvement and 10 patients experienced complete control of urticaria. Improvement occurred at an average of 4 weeks and at a range of dose

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    Funding sources: None.

    Conflicts of interest: None declared.

    Reprints not available from the authors.

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    Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.