Mycophenolate mofetil for ocular inflammation
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, 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
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.
(c) 2010 Elsevier Inc. All rights reserved.
Source: PubMed