Eczema Medication Series – Cellcept

This is a series on some of the medication that I’ve collated from parents who shared in forums. My baby with eczema hadn’t been prescribed these, but my usual investigative self got interested after reading mixed feedback on these medicines. Do share in the comments your child’s experience, and the effect on his/her eczema.

What is Cellcept?

Cellcept is the product name for mycophenolate mofetil, which is an immunosuppressant. Similar to cyclosporine, it is prescribed to lower the risk of organ (kidney, heart or liver) transplant rejection via lowering the activity of the immune system.  It is also prescribed for Crohn’s disease. It may also be prescribed for those with severe eczema who has not been responded to conventional treatments over prolonged periods.

It can be taken orally or by intravenous infusion, and patient needs to follow the prescription carefully, including how many hours to take it before food. The capsule or tablet should be swallowed whole, not crushed or chewed and thus ask for a suspension if you have problems swallowing whole. For the medication in this series that work on the immune system, altering the dosage of the same drug can be used to treat different conditions. Thus, it is important to follow the dosage and frequency designed by your doctor and not to self-adjust through your own observation of the skin’s condition. Doing so not only risks side effects, it also makes it difficult for your doctor to prescribe a follow-up treatment.

Monitoring

Certain tests may be requested by your doctor to assess the side effects of Cellcept, such as blood tests (blood count and chemistry panel), particularly to monitor the blood count of white blood cells, red blood cells and platelets.

Warning

There are medications that can reduce the amount of the active ingredient of Cellcept in the bloodstream, thus making it less effective. Some of these are antacids, colestyiramne, iron tablets, ciclosporin and rifampicin. It’s best to let your doctor know of medication, vitamins and supplements that you are taking.

There is associated risk of   lymphoma and skin cancer, so sun protection measures are important. Also take good care of your gums and visit dentist regularly as swollen gums is a possible side effect. Do not drive as a possible side effect is dizziness. Avoid contact with people who are ill, and also those who have taken a recent live vaccine (also check with the doctor before getting vaccinated) as Cellcept is an immunosuppressant. Wash your hands also to prevent infection.

Side Effects

Watch for side effects, and let your doctor know; some of the side effects are:

Constipation, stomach upset, gas, chills, fever, rash, swelling, headache, vomiting, diarrhea, nausea, loss of appetite, hair loss,  swollen gums, bleeding, bruising, paleness, difficulty breathing, excessive fatigue, yellowing of skin or eyes, muscle cramps, water retention and increased heartbeat.

Symptoms of flu such as sore throat, fever, night sweats, or painful urination, vision changes, reddened skin that cannot heal or sore may indicate infection that warrant seeing your doctor.  Stomach or intestinal bleeding is also a side effect, and signs to look out for are stomach pain, blood in your stool, or dark, sticky stools. There are also reports of risk of brain infection (progressive multifocal  leukoencephalopathy) whose symptoms include visual loss, seizures, movement and speech difficulties, weakness, confusion and headaches. Do call your doctor immediately.

Refer here for a list of more to less common side effects.

There is no particular diet to follow, unless directed by your doctor.

Most Importantly, Does it Work?

I’ve found a few studies online, and the various conclusions are:

1. In a retrospective case series of 14 children with severe eczema, 1 failed to respond to treatment while others improved significantly.
2. In a study of 16 patients over 34 weeks, 1 had pancreatic cancer and the rest had improved significantly.
3. In a retrospective study of 20 patients, 17 improved over 4 weeks of the course, but 7 patients developed various infections.
4. In a study of 12 patients with paediatric severe eczema at the University of North Carolina at Chapel Hill pediatric dermatology clinic, 8 out of 12 reported significant improvement.
5. In this study of 10 adult patients, mycophenolate mofetil is found to be effective in reducing the severity of eczema after 12 weeks.

A point to note is above studies were small sample sizes (and I’ve found a few others of even smaller sizes), possibly due to methotrexate prescribed only for severe instances that had not responded to corticosteroids or cyclosporine. Do share your experience in the comments!