How to uptitrate Myfortic (Mycophenolic acid) in a patient with eczema?

From the Guidelines

Myfortic (mycophenolate sodium) uptitration in eczema patients should begin with a low dose of 360 mg twice daily and gradually increase to a target dose of 720 mg twice daily over 2-4 weeks, as recommended for adults with refractory moderate to severe atopic dermatitis 1. When uptitrating Myfortic, it is essential to monitor baseline complete blood count, liver function, and renal function before initiating therapy.

• Increase the dose by 360 mg every 1-2 weeks as tolerated, watching for gastrointestinal side effects like nausea, vomiting, or diarrhea which are common.
• If side effects occur, temporarily maintain the current dose until symptoms resolve before continuing uptitration. Regular blood monitoring should be performed every 2 weeks during uptitration and monthly thereafter, including complete blood count to watch for myelosuppression and liver/kidney function tests, as mycophenolate mofetil is not approved by the FDA for use in AD and comorbidities or drug interactions that may exacerbate toxicity make this intervention inappropriate for select patients 1. Patients should be advised to take Myfortic with food to minimize gastrointestinal effects and to avoid sun exposure due to increased photosensitivity. The therapeutic effect may take 4-8 weeks to become apparent, so patience is necessary during the uptitration period. Myfortic works by inhibiting lymphocyte proliferation and antibody formation, thereby reducing the inflammatory response in eczema patients who haven't responded adequately to conventional therapies, and for adults with refractory moderate to severe AD, mycophenolate mofetil is conditionally recommended with proper monitoring 1.

From the Research

Uptitration of Myfortic in Eczema Patients

• The study 2 suggests that Myfortic (enteric-coated mycophenolate sodium) can be effective in treating severe recalcitrant adult atopic dermatitis at a dose of 720 mg twice daily for 6 months.
• However, there is no specific guidance on how to uptitrate Myfortic in eczema patients.
• The study 3 provides information on the use of mycophenolate mofetil (MMF) in patients with refractory atopic dermatitis, but does not provide details on uptitration.
• It is essential to monitor patients closely for adverse effects and adjust the dose accordingly, as seen in the study 2 where only mild adverse effects were reported.

Dosage and Administration

• The initial dose of Myfortic used in the study 2 was 720 mg twice daily.
• The study 3 reports an average time for initial effects of 6.8 weeks, suggesting that patients may need to be on the medication for several weeks before seeing significant improvements.
• The decision to uptitrate Myfortic should be based on the patient's response to treatment and the presence of any adverse effects, as well as guidance from well-designed, long-term trials 4.

Safety and Efficacy

• The study 2 reports significant decreases in disease activity and serum TARC levels, as well as total serum IgE levels, after treatment with Myfortic.
• The study 3 reports a significant reduction in pre to post SCORAD scores, indicating improved disease control.
• However, the study 3 also reports that prolonged duration of treatment (≥1 year) was associated with herpes infections, highlighting the need for ongoing monitoring for infections that may develop on long-term therapy 3.