Mycophenolate mofetil (MMF) is an immunosuppressive drug used in
renal transplantation,
lupus nephritis and
pemphigus vulgaris patients. An apparent link is described between the use of MMF with
prednisone to treat
pemphigus vulgaris and the development of red blood cell
anemia. Specifically, after initiation of 500 mg MMF twice a day given in conjunction with the long-standing use of
prednisone, which had been tapered to a dose of 10 mg daily, the patient's red blood cell count dropped by 17% over 7 weeks. To put this into perspective, total aplasia of red blood cells for 40 days would result in a drop of 30-33% in the red blood cell count. In the
transplantation literature, MMF has been noted to lower red blood cell counts. One previous study of four transplant patients whose immediate post-
transplantation immunosuppression utilized
corticosteroids,
cyclosporine, MMF, and
anti-T-lymphocyte
globulin noted
anemia in 13% of them. The dermatology literature heretofore has not noted that
anemia is a side effect of patients taking MMF to treat
pemphigus. This report suggests that
anemia can occur due to MMF, in particular when it is given with
prednisone, a side effect well documented in the
transplantation literature when the triple combination of MMF,
cyclosporine and
prednisone is used. It would therefore seem prudent to monitor red and white blood cell counts in patients taking MMF. A review of the literature also reveals that MMF is a safe medication that appears to have a more favorable side effect profile than
azathioprine, although it is more expensive than
azathioprine.