Characteristics of patients who attain remission of inflammatory eye disease following treatment and discontinuation of mycophenolate mofetil

Abstract

Purpose: This study aimed to characterize the long-term outcomes of patients with uveitis following successful disease suppression with mycophenalate mofetil (MM), a form of steroid-sparing immunomodulatory therapy (IMT). Experience suggests that once patients’ inflammation can be successfully controlled with IMT, there may be long-term benefit to disease control even following discontinuation of the medication.

Methods: A retrospective chart review was conducted to identify patients treated by a single ocular immunologist at a tertiary referral center who were started on mycophenolate mofetil (MM) for uveitis. Inclusion criteria were successful disease suppression with MM, discontinuation of the medication and at least three years of subsequent follow-up. 36 patients met these criteria. Additional factors examined included duration of MM use, concurrent use of other IMT, age and gender.

Results: 28/36 (78%) consecutive patients meeting the inclusion criteria achieved successful disease remission following treatment with mycophenolate mofetil (MM). These patients were treated for a variety of anterior, intermediate as well as posterior uveitic diseases. 72% of patients who attained remission were female and their average age at beginning of MM treatment was 43 years old (range 30 to 61). 75% of patients experiencing relapse of disease were female and their average age was 31 years old (range 17 to 38). Average duration of MM treatment in patients who attained remission was 29 months (range 16 to 40) and 32 months (24 to 40) for those who developed recurrent disease. The average time to relapse was 25 months (range 20 to 28). 14% of patients who achieved remission, versus 38% of those who did not, required concurrent treatment with other IMT during the time of administration of MM.

Conclusions: 78% of patients treated with mycophenolate mofetil (MM) achieved long-term remission after control and discontinuation of the medication. The need for concurrent IMT was greater in the group who relapsed within three years following treatment with MM. This is thought to be related to cases that were more difficult to control. Duration of treatment with MM, age and gender were not correlated with post-treatment relapse. These results will aid ophthalmologists when counseling patients with uveitis and choosing immunomodulatory therapy.

Keywords: 745 uvea • 557 inflammation • 555 immunomodulation/immunoregulation