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Mikael Guedj, Dominique Monnet, Antoine P. Brézin; Comparative Follow-up Of Cyclosporine And Mycophenolate Mofetil For The Treatment Of Birdshot Chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4396.
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To compare the effectiveness of cyclosporine A and mycophenolate mofetil as corticosteroid-sparing therapy in patients with birdshot chorioretinopathy.
An open cohort of 211 patients with birdshot chorioretinopathy was examined in a standardized manner yearly from 2002 to 2010 in a single referral center. Only patients with active forms of the disease were included. Disease activity was defined by macular edema judged by angiography or OCT, and/or retinal vasculitis on angiography. Patients treated by immunosuppressants prior to study entry were excluded. The effect of cyclosporine treatment was compared to the effect of mycophenolate in all patients followed for at least one year. The main outcome measure was the proportion of patients reaching treatment success at the one year follow-up, defined as patients who did not need a rescue-therapy by intra- or peri-ocular injections of triamcinolone, and who could be weaned off to a daily dose of prednisone ≤ 10 mg.
In our study cohort, 112 patients were treated by immunosuppressive therapy and 43 patients (17 males and 26 females, mean age 53.1 years) met the above inclusion criteria, with macular edema in 23 (53%) cases and retinal vasculitis in 32 (74%) cases. Cyclosporine was prescribed in 28 patients (mean dose: 3 mg/kg/day) and mycophenolate in 15 patients (mean dose: 1.6 g/day). The first intent immunosuppressant was cyclosporine in 2002-2008, and mycophenolate hence after. There were no significant differences in age or in frequency of macular edema or retinal vasculitis at the time treatment was initiated in both groups. Oral prednisone was concomitantly initiated in a greater number of cases in the cyclosporine group [28 (100%) cases] than in the mycophenolate group [5 (33%) cases], while triamcinolone injections performed prior to the one-year evaluation were more frequent in the mycophenolate group [21 injections (1.4 per patient-year)] than in the cyclosporine group [26 injections (0.9 per patient-year)]. Treatment success was observed in 18 (72%) cases in the cyclosporine group and in 4 (33%) cases in the mycophenolate group (p=0.007).
The rate of treatment success differed between cyclosporine and mycophenolate groups. However, these results might be related to the evolution of treatment practices over the study period, in particular regarding concomitant corticosteroid treatment, as well as the differential effectiveness of cyclosporine and mycophenolate.
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