Combined mycophenolate mofetil and cyclosporin therapy for severe recalcitrant psoriasis

The use of combination oral therapies in the management of severe psoriasis is gaining increasing acceptance. We report the concurrent use of mycophenolate mofetil (MMF) (maximum dose 3.0 g daily) with low-dose cyclosporin (mean dose 2.5 mg/kg/day) in nine patients with severe psoriasis. All had previously failed on other systemic therapies. They were all initially on treatment with cyclosporin alone which had either failed to clear their psoriasis or they were unable to tolerate higher doses. After the addition of MMF there was good clinical improvement in three patients and moderate disease control in a further four patients after a follow-up period of 3-11 months, with no additional evidence of toxicity at the doses used. We believe that MMF may be useful in some psoriatic patients unresponsive to or intolerant of other treatments or who are at risk of developing nephrotoxicity at higher doses of cyclosporin.