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Careen Y. Lowder, Mariam Khan, Rula Hajj-Ali; Retrospective Case Series of Single Center Experience of Methotrexate and Mycophenolate Mofetil Monotherapy for Patients with Non Infectious Posterior, Intermediate and Panuveitis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4262.
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© ARVO (1962-2015); The Authors (2016-present)
To report sustained clinical efficacy in patients with non infectious posterior, intermediate and panuveitis treated with mycophenolate mofetil (MMF) and/or methotrexate (MTX).
183 charts of patients followed in the Rheumatology and Ophthalmology Departments between 1997 and 2008 with the diagnosis of uveitis were screened. 36 patients fulfilled the inclusion criteria: a) diagnosis of non infectious posterior, intermediate or panuveitis, b) treatment with MTX and/or MMF monotherapy, c) at least six months of follow up after treatment initiation. Data extracted included demographics, treatment course and response, and disease associations. Initial clinical efficacy was defined as lack of inflammation at a prednisone dose of less than 10mg without prior intraocular steroid injection. Primary outcome measure was sustained efficacy defined as lack of inflammation for at least six months following initial efficacy. Efficacy was not sustained if patients needed escalation of immunosuppressive agents, intraocular steroid injections or course of oral steroids.
30 patients received MTX, 11 received MMF (5 de novo and 5 after MTX failure). 53% (19) had idiopathic disease, 17% (6) had ocular syndromes restricted to the eye and 30% (11) had systemic disease: sarcoidosis (64%,7), multiple sclerosis (18%,2), behcet's (9%,1), crohn's disease (9%,1). 56% (20) had panuveitis, 42% (15) had posterior uveitis. One had intermediate uveitis. 5 patients treated with MMF de novo had birdshot retinochoroidopathy (80%,4). Female to male ratio was 1.6:1. Mean disease duration was 7.7 years (1-20), mean age at diagnosis was 43.5 years (8-65). Average dose of MTX was 21 mg weekly (15-27.5) and of MMF was 2318 mg daily (1000-3000). Initial and sustained clinical efficacy were higher in MMF compared to MTX (73% vs. 67 %, p =0.12) and (64 % vs. 47% p =0.16) respectively but this did not reach statistical significance. There was a trend towards significance with respect to steroid sparing effect (60% vs. 22%, p=0.069) and ability to taper antimetabolite (55% vs. 17%, p=0.06) in the MMF group compared to the MTX group respectively. Median duration of sustained clinical efficacy was significantly higher in the MMF compared to MTX group (48 vs. 20 months, p=0.002).
Sustained clinical efficacy in patients who received MTX was higher compared to the reported literature. Median duration of sustained efficacy was higher with MMF compared to MTX.
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