What is Mycophenolate?
Mycophenolate, or more properly Mycophenolic Acid, is an immunosuppressant drug. That means that it reduces the activity of the body’s immune (or defence) system. It may seem strange that a drug which reduces our ability to ward off danger could have any beneficial use at all. However, there are times when it is helpful or even vital to reduce the effectiveness of our immune system. The best example is to prevent the body rejecting a new organ following transplantation.
Mycophenolate is also used to treat certain inflammatory conditions such as Lupus and Vasculitis, where the immune system has become overactive and requires damping down.
Mycophenolate as a treatment for long-term CRPS
Everyone agrees that current available treatments for long-term CRPS are, at best, woefully inadequate. Certainly, most current drug trials and other therapies seem more focused on (and are achieving better results in) early stage CRPS.
With that in mind, researchers at the University of Liverpool led by renowned CRPS researcher, Dr Andreas Goebel, have turned their thoughts to Mycophenolate. They explained that “with accruing evidence to support an underlying immunological process and anecdotal evidence suggesting potential efficacy of mycophenolate, we wished to explore the feasibility and effectiveness of this treatment in patients with CRPS.”
The results of their small-scale, pilot and feasibility study were published earlier this year.
A total of 12 people were recruited to the trial. Each had been suffering CRPS for two years or more and, on assessment, recorded a moderate or high pain intensity score on a numeric rating scale.
For a 5½ month period, each patient was randomly selected to receive either their usual medication only or their usual medication plus Mycophenolate. That was then reversed for a further period of 5½ months, so 11 months in total. For each period, the outcome was assessed by reference to average pain intensity scores recorded over 14 days between 5 and 5½ months. Other factors such as skin sensitivity were also assessed.
Nine patients “provided outcomes and were analysed for the main outcome.” Overall, the researchers recorded that Mycophenolate was “significantly more effective” than the patients’ usual medication only, with “four treatment responders (to mycophenolate treatment either before, or after switch), whose initial exquisite skin hyper-sensitivities, function and quality of life strongly improved.”
However, there were side effects; “itchiness, skin-cryptitis, increased pain, and increased depression caused 45% of the subjects to stop taking mycophenolate.”
Finding that “Mycophenolate appears to reduce pain intensity and improve quality of life in a subgroup of patients with persistent CRPS”, the researchers concluded that the results support the feasibility of conducting a larger scale trial.
Side effects were clearly a significant issue. However, it may well be that as a result of further study, researchers and ultimately clinicians will be better able to identify and select those patients more likely to tolerate and respond well to Mycophenolate.
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