From the Guidelines
Patients with diffuse scleroderma typically begin to see improvements on mycophenolate (MMF) after 12 months of consistent therapy, as evidenced by a modest improvement in the modified Rodnan skin score (mRSS) in all groups at 12 months 1. The standard dosing regimen is usually 1,000-1,500 mg twice daily (total daily dose of 2,000-3,000 mg), with the dose often started lower and gradually increased to minimize gastrointestinal side effects. Some key points to consider when treating patients with diffuse scleroderma with mycophenolate include:
- Improvement is generally measured by stabilization or reduction in skin thickening (modified Rodnan skin score), better lung function tests in those with interstitial lung disease, and reduced progression of other organ involvement.
- Patients should understand that mycophenolate works gradually by modulating the immune system and reducing fibrosis, rather than providing immediate symptom relief.
- Regular monitoring is essential, including complete blood counts, liver function tests, and kidney function tests every 1-3 months, as the predominant adverse event is leucopenia 1.
- Patients should continue other supportive therapies while on mycophenolate, as it is part of a comprehensive treatment approach.
- The medication needs to be taken consistently long-term, as premature discontinuation may lead to disease flares.
- Some patients may require 18-24 months before maximum benefit is achieved, and individual responses vary considerably.
From the Research
Improvement Timeline for Diffuse Scleroderma Patients on Mycophenolate
- The time it takes to see an improvement in diffuse scleroderma patients who are on mycophenolate can vary, but studies suggest that improvements can be seen as early as 3 months after starting treatment 2.
- One study found that the modified Rodnan skin score (mRSS) decreased significantly after 12 months of mycophenolate treatment, with a mean decrease of 7.59 points 2.
- Another study reported that patients with diffuse progressive cutaneous systemic sclerosis experienced a significant decrease in mRSS after 18.2 months of mycophenolate therapy, with a mean decrease of 10.04 points 3.
- Improvements in skin involvement and stabilization of pulmonary function have also been reported in patients with diffuse scleroderma who were treated with mycophenolate for up to 24 months 4.
Factors Influencing Improvement
- The effectiveness of mycophenolate in improving skin and lung disease in patients with diffuse scleroderma may depend on various factors, including disease duration and severity 5.
- Studies have reported that mycophenolate can be effective in improving or stabilizing interstitial lung disease and skin involvement in patients with diffuse scleroderma 2, 3, 4, 5.
- However, gastrointestinal adverse events are common in patients with systemic sclerosis who are treated with mycophenolate, although they are not usually severe enough to preclude its use 5.