(MMF), a semisynthetic DMARD, is converted to mycophenolic acid, the active
form of the drug. The active product inhibits inosine monophosphate
dehydrogenase,leading to suppression of T- and B-lymphocyte proliferation.
Downstream, it interferes with leukocyte adhesion to endothelial cells through
inhibition of E-selectin, P-selectin, and intercellular adhesion molecule 1.
is effective for the treatment of renal disease due to systemic lupus
erythematosus and may be useful in vasculitis and Wegener’s granulomatosis.
Although MMF is occasionally used at a dosage of 2 g/d to treat rheumatoid
arthritis, there are no well-controlled data regarding its efficacy in this
MMF is associated with
nausea, dyspepsia and abdominal pain. Like azathioprine, it can cause
hepatotoxicity although it is not associated with the acute febrile
hepatotoxicity of that drug. MMF can cause leukopenia, thrombocytopenia, and
anemia. MMF is associated with an increased incidence of infections. It is only
rarely associated with malignancy.