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Effect of mycophenolate mofetil on the white blood cell count and the frequency of infection in systemic lupus erythematosus

  • Original Article - Safety and Pharmacovigillance
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Abstract

Leukopenia is a common manifestation of SLE. Addition of immunosuppressive therapy in a SLE patient who is already leukopenic is a clinical concern. It could worsen leukopenia, increase the risk of infection, or both. The aim of this study was to analyze the immediate effect of mycophenolate mofetil on the white blood cell count and the rate of infection in SLE patients. Two hundred and forty-four patients within the Hopkins Lupus Cohort who were newly started on mycophenolate mofetil were included in the study. The white blood cell count and interval infection history on the day mycophenolate mofetil was started were compared with the white blood cell count and interval infection history at the next visit. The study was based on 244 patients who began taking mycophenolate mofetil in the cohort. The study population included 47 % African Americans, 44 % Caucasians, and 9 % other ethnicities. There was a slight but not statistically significant increase in the white blood cell count (6.63 vs. 7.01), after starting mycophenolate mofetil. Patients with a baseline white blood cell count <3000/mm3 did have a statistically significant increase in the white blood cell count after starting mycophenolate mofetil (2.57 vs. 5.13, P = 0.0047). We also found a statistically significant increase in the risk of bacterial infection (but not viral infection) after starting mycophenolate mofetil (4 vs. 9 %, P = 0.0036). Leukopenia does not worsen with mycophenolate mofetil. However, mycophenolate mofetil appears to slightly increase the rate of bacterial (but not viral) infection.

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Acknowledgments

The Hopkins Lupus Cohort is supported by a Grant from the National Institute of Health (NIH AR 43727). This publication was also made possible by Grant Number UL1 RR 025005 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research.

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Authors and Affiliations

  1. Department of Medicine, Thomas Jefferson University Hospital, 833 Chestnut Street, Suite 701, Philadelphia, PA, 19107, USA

    Ananta Subedi

  2. Department of Epidemiology and Public Health, University of Maryland, 660 West Redwood Street, Baltimore, MD, 21201, USA

    Laurence S. Magder

  3. Division of Rheumatology, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7500, Baltimore, MD, 21205, USA

    Michelle Petri

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  1. Ananta Subedi
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  2. Laurence S. Magder
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  3. Michelle Petri
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Correspondence to Ananta Subedi.

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Subedi, A., Magder, L.S. & Petri, M. Effect of mycophenolate mofetil on the white blood cell count and the frequency of infection in systemic lupus erythematosus. Rheumatol Int 35, 1687–1692 (2015). https://doi.org/10.1007/s00296-015-3265-6

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  • DOI: https://doi.org/10.1007/s00296-015-3265-6

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