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Manoel Gusmao Isidro, Viviane Sakata, Daniel Cavalcanti, Juliana Zaghetto, Edilberto Olivalves, Carlos Hirata, Joyce Yamamoto; Mycophenolate Mofetil in Refractory Non-infectious Uveitis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5392.
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To evaluate the effectiveness of Mycophenolate Mofetil (MMF) as an immunossupressive agent for refractory non-infectious uveitis.
Data from patients with non-infectious uveitis, followed in the Uveitis Service, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil, under MMF (1-3g/day) oral therapy during 2007-2012 period were retrospectively analyzed. Treatment duration was at least 6 months. Patients were evaluated at 6 (T6) and 12 months (T12) after maximum dosage was achieved. Primary outcomes were success in gaining complete control of inflammation, success in maintaining control of inflammation after tapering of prednisone to ≤10mg/day (at least for 28 days) and discontinuation of treatment. Secondary outcomes were partial improvement in inflammation and use of other immunopressant after MMF therapy start. Clinical activity was evaluated according to SUN guidelines. Fluorescein angiography (FA) and optical coherence tomography (OCT) were analyzed when indicated. This study was approved by Institutional Ethics Committee Board (0621/11).
Seventeen patients (Vogt-Koyanagi-Harada disease, 5; Behcet disease, 4; idiopathic retinal vasculitis, 3; intermediate uveitis, 3; HLA-B27 +ve ankylosing spondylitis,1; idiopathic diffuse uveitis,1) with a mean age of 40±15 years (14-59 y) were included. Nine patients (53%) were male. The mean duration of inflammation prior to achieving MMF maximum dosage was 85.9±73.6 mo (24-276mo). All patients at MMF start (T0) had previously taken other immunossupressant/biologic agent (cyclosporine, 14; azathioprine, 13; methotrexate,2; chlorambucil, 3; cyclophosphamide,2; infliximab, 2; adalimumab,2). Complete control of inflammation was achieved in 7 (41.2%) and in 6 patients (37,5%) at T6 and T12, respectively. Four out of 10 patients (40%), who were taking prednisone >10mg/d at T0, were succeeded in reducing prednisone to ≤10mg/d and in mantaining sustained inflammatory control during the follow up. One patient discontinued MMF due to side effects after 11mo. Partial control of inflammation was observed in 9 patients (52.9%) and in 8 patients (47.1%) at T6 and T12, respectively. 85% of those with complete control of inflammation had no additional immunossupressant at T6 and T12.
Our results show that MMF is an effective immunossupressant in patients with refractory non-infectious uveitis presenting few side effects.
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