Abstract
Purpose:
To evaluate the effectiveness of combination chemotherapy (CC) with Mycophenolate mofetil (MMF) and cyclosporin A (CsA) in refractory uveitis.
Methods:
Retrospective, non comparative, cohort study. Ninety-three patients (177 eyes) who had CC with CsA and MMF during their course of treatment for uveitis and had a minimum follow up of 12 months with combination therapy. We analysed the efficacy, complications, and outcomes of CC. Ability to control ocular inflammation with CC at 6 and 12 months and corticosteroid sparing effect were main outcome measures. Discontinuation of therapy due to intolerance to medications or other reasons were also analysed. Efficacy of control of inflammation by CC was evaluated from the start of CC to sustained improvement of global disease activity by CC. Corticosteroid-sparing effect was defined as the ability of CC to control ocular inflammation with total absence (0 mg) of oral, periocular or topical corticosteroids.
Results:
In the study group, 75.3% patients by 6 months and 80.8% by 12 months achieved complete control of inflammation. Twenty-eight percent of patients required additional therapy with biologics. Additional surgeries were done for complete control of inflammation in 4.3% patients. Control of inflammation was 80.8% at 6 months and 84.2% at 12 months follow up in birdshot retinochoroidopathy (BSRC) patients and 77.3% at 6 months and 81% at 12 months for panuveitis patients. For patients with associated vasculitis, control of inflammation was 52.9% at 6 months and 62.5% at 12 months. Pars planitis patients had a very poor outcome (25% at 6 months and 0% at 12 months) with CC. Complete corticosteroid sparing success was achieved in 69.9% patients. Oral steroids were used in 10.8% patients and episodic periocular or topical steroids were given in 17.2% patients. Sixteen percent of patients stopped CC due to intolerance; 19.4% and 7.5% developed toxicity to CsA and MMF, respectively. In 4.3% patients, CC was stopped due to insurance/non-compliance.
Conclusions:
Combination chemotherapy with CsA and MMF is highly effective in controlling ocular inflammation in patients with BSRC and with panuveitis, but not with retinal vasculitis or with pars planitis. Efficacy and tolerance were better with these medications when they were given as combination than as monotherapy.
Keywords: 555 immunomodulation/immunoregulation •
462 clinical (human) or epidemiologic studies: outcomes/complications •
745 uvea