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Mycophenolic acid in psoriasis
Abstract:
Mycophenolic acid (MPA) is a fermentation product of a penicillium mould which has shown antitumour acitivity in certain animal models. It blocks nucleic acid synthesis by interfering with the interconversions of inosine monophosphate (IMP), xanthine monophosphate (XMP) and guanine monophosphate (GMP) thereby inhibiting growth and/or replication of tumour cells. In vivo activity depends on the presence of a beta-glucuronidase which is abundant in the cell wall of epithelial tissues. Encouraged by results obtained in earlier clinical trials, we have studied 28 patients with psoriasis, 21 in double-blind fashion. A comparison of disease severity in patients before and after receiving MPA versus patients receiving placebo clearly showed the superiority of drug over placebo. The mean severity score of patients receiving MPA as an initial course of therapy improved by 56% versus 9% in patients receiving placebo. Patients receiving MPA after an initial course of placebo therapy showed improvement in their mean severity score averaging 86%. Those patients receiving placebo after an initial course of MPA showed worsening of their mean severity score averaging 70%. Overall, about 75% of MPA treated patients have shown good to excellent responses, and toxicity appears low. Evidence suggests that MPA may be very useful in treating severe psoriasis.
Insights
Mycophenolic acid (MPA) effectively treats severe psoriasis by inhibiting nucleic acid synthesis. Clinical trials show significant disease severity improvement in patients receiving MPA compared to placebo.
Area of Science:
- Immunology
- Dermatology
- Pharmacology
Background:
- Mycophenolic acid (MPA) is a potent inhibitor of nucleic acid synthesis.
- MPA demonstrates antitumour activity by targeting purine biosynthesis pathways.
- In vivo efficacy of MPA is linked to beta-glucuronidase activity in epithelial tissues.
Purpose of the Study:
- To evaluate the efficacy and safety of Mycophenolic acid (MPA) in treating severe psoriasis.
- To compare the therapeutic effects of MPA against a placebo in a double-blind clinical trial.
Main Methods:
- A double-blind, placebo-controlled study involving 28 patients with psoriasis.
- Assessment of disease severity scores before and after treatment with MPA or placebo.
- Cross-over design to evaluate MPA efficacy after initial placebo treatment and vice versa.
Main Results:
- MPA treatment resulted in a 56% improvement in mean severity scores, significantly outperforming the 9% improvement with placebo.
- Patients switched to MPA from placebo showed an 86% improvement, while those switched to placebo from MPA worsened by 70%.
- Approximately 75% of patients receiving MPA experienced good to excellent responses with low toxicity.
Conclusions:
- Mycophenolic acid demonstrates significant efficacy in treating severe psoriasis.
- MPA offers a promising therapeutic option for psoriasis management with a favorable safety profile.