Mycophenolate mofetil for ocular inflammation.

Abstract

PURPOSE:

To evaluate mycophenolate mofetil as a single noncorticosteroid immunosuppressive treatment for noninfectious ocular inflammatory diseases.

DESIGN:

Retrospective cohort study.

METHODS:

Characteristics of patients with noninfectious ocular inflammation treated with mycophenolate mofetil at 4 subspecialty clinics from 1995 to 2007 were abstracted by expert reviewers in a standardized chart review of every eye at every visit. Main outcomes measured were control of inflammation, corticosteroid-sparing effects, and discontinuation of mycophenolate mofetil (including the reasons for discontinuation). Survival analysis was used to estimate the incidence of outcomes, and to identify risk factors for each.

RESULTS:

Among 236 patients (397 eyes) treated with mycophenolate mofetil monotherapy, 20.3%, 11.9%, and 39.8% had anterior uveitis, intermediate uveitis, and posterior uveitis or panuveitis respectively; 14% had scleritis; 7.6% had mucous membrane pemphigoid; and 6.4% had other ocular inflammatory diseases. By Kaplan-Meier estimation, complete control of inflammation--sustained over consecutive visits spanning at least 28 days--was achieved in 53% and 73% of patients within 6 months and 1 year respectively. Systemic corticosteroid dosage was reduced to 10 mg of prednisone or less, while maintaining sustained control of inflammation, in 41% and 55% of patients in 6 months and 1 year respectively. Twelve percent of patients discontinued mycophenolate mofetil within the first year because of side effects of therapy.

CONCLUSIONS:

Given sufficient time, mycophenolate mofetil was effective in managing ocular inflammation in approximately half of the treated patients. Treatment-limiting side effects were observed in 12% of patients and typically were reversible.

• Authors: Ebenezer Daniel, Jennifer E Thorne, Craig W Newcomb, Siddharth S Pujari, R Oktay Kaçmaz, Grace A Levy-Clarke, Robert B Nussenblatt, James T Rosenbaum, Eric B Suhler, C Stephen Foster, Douglas A Jabs, John H Kempen
• Journal: American journal of ophthalmology (Am J Ophthalmol) Vol. 149 Issue 3 Pg. 423-32.e1-2 (Mar 2010) ISSN: 1879-1891 [Electronic] United States
• PMID: 20042178 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
• Copyright: (c) 2010 Elsevier Inc. All rights reserved.

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Immunosuppressive Agents
• Mycophenolic Acid
• Prednisone

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anti-Inflammatory Agents, Non-Steroidal (adverse effects, therapeutic use)
• Child
• Female
• Follow-Up Studies
• Humans
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Male
• Middle Aged
• Mycophenolic Acid (adverse effects, analogs & derivatives, therapeutic use)
• Pemphigoid, Benign Mucous Membrane (drug therapy, physiopathology)
• Prednisone (administration & dosage)
• Retrospective Studies
• Risk Factors
• Scleritis (drug therapy, physiopathology)
• Treatment Outcome
• Uveitis (drug therapy, physiopathology)
• Visual Acuity (physiology)