Mycophenolate mofetil in the treatment of non‐renal manifestations of systemic lupus erythematosus: a review

Mycophenolate mofetil (MMF) is efficacious in the management of transplantations and lupus nephritis. It is also useful in the treatment of autoimmune conditions as its mechanisms of action target the T‐ and B‐lymphocytes, leading to suppression of the cell‐mediated immune responses and antibody formation. It has been used successfully in immune‐mediated conditions like myasthenia gravis, autoimmune hepatitis and immune cytopenias. However, its optimal use in non‐renal manifestations (haematological, neuropsychiatric, myocardial, pulmonary, curaneous) in lupus patients are unclear and predominantly based on anecdotal reports. There are yet to be randomised controlled trials to guide the optimal doses and durations of MMF in such situations. MMF is relatively well tolerated and safe to use, though there are reports of serious adverse effects like urticaria, myopathy, Epstein‐Barr virus‐associated B‐cell lymphoma, cytomegalovirus infections and disseminated varicella zoster. Another area of concern for patients is the increased cost of using long‐term MMF. A practical approach for rheumatologists would be to use a dosing regimen guided by data from lupus nephritis trials and using MMF mainly in those lupus patients with non‐renal manifestations failing conventional therapy.