The outcomes of mycophenolate mofetil therapy combined with systemic corticosteroids in acute uveitis associated with Vogt-Koyanagi-Harada disease.

Abstract

PURPOSE:

To study the effectiveness of mycophenolate mofetil (MMF) as first-line therapy combined with systemic corticosteroids in acute uveitis associated with Vogt-Koyanagi-Harada (VKH) disease. The outcomes in this group were compared with those of another group of patients with VKH disease who were treated with corticosteroid monotherapy or with delayed addition of immunomodulatory therapy.

METHODS:

This prospective study included 19 patients (38 eyes) diagnosed with acute uveitis associated with VKH disease.

RESULTS:

The mean follow-up period was 27.0 ± 11.1 months (range 16-54 months). Corticosteroid-sparing effect was achieved in all patients. The mean interval between starting treatment and tapering prednisone to 10 mg or less daily was 5.1 ± 1.2 months (range 3-7 months). Ten (53%) patients discontinued treatment without relapse of inflammation. The mean time observed of treatment was 17.3 ± 11.9 months (range 3-41.5 months). Visual acuity of 20/20 was achieved by 38% of the eyes in the corticosteroid group and by 74% in the corticosteroid + MMF group (p < 0.001). Recurrent inflammation of ≥3 times was reduced significantly (p = 0.0383) in the corticosteroid + MMF group (3%) as compared to corticosteroid group (18%). Development of all complications was significantly higher in the corticosteroid group (43%) compared with the corticosteroid + MMF group (8%) (p < 0.001). None of the eyes in the corticosteroid + MMF group developed 'sunset glow fundus'.

CONCLUSIONS:

Addition of MMF as first-line therapy to corticosteroids in patients with acute uveitis associated with VKH disease leads to significant reduction in recurrences of uveitis and development of late complications and significantly improves visual outcome.

• Authors: Ahmed M Abu El-Asrar, Suhail Hemachandran, Hani S Al-Mezaine, Dustan Kangave, Abdulrahman M Al-Muammar
• Journal: Acta ophthalmologica (Acta Ophthalmol) Vol. 90 Issue 8 Pg. e603-8 (Dec 2012) ISSN: 1755-3768 [Electronic] England
• PMID: 22971163 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.

Chemical References

• Coloring Agents
• Glucocorticoids
• Immunosuppressive Agents
• Mycophenolic Acid
• Indocyanine Green
• Prednisone
• Methylprednisolone

Topics

• Acute Disease
• Administration, Oral
• Adolescent
• Adult
• Child
• Coloring Agents
• Drug Therapy, Combination
• Female
• Fluorescein Angiography
• Follow-Up Studies
• Glucocorticoids (administration & dosage, therapeutic use)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Indocyanine Green
• Infusions, Intravenous
• Male
• Methylprednisolone (administration & dosage, therapeutic use)
• Mycophenolic Acid (analogs & derivatives, therapeutic use)
• Ophthalmoscopy
• Prednisone (administration & dosage, therapeutic use)
• Prospective Studies
• Secondary Prevention
• Treatment Outcome
• Uveitis, Posterior (diagnosis, drug therapy, etiology)
• Uveomeningoencephalitic Syndrome (complications, diagnosis, drug therapy)
• Visual Acuity (physiology)
• Young Adult