Mycophenolate Mofetil in Non-Infectious Ocular Inflammatory Diseases

Abstract

Purpose: : To evaluate the control of inflammation with mycophenolate mofetil monotherapy in patients with non-infectious ocular inflammatory diseases.

Methods: : A retrospective cohort study of consecutive patients with non-infectious ocular inflammation observed to start mycophenolate mofetil as a sole non-corticosteroid immunosuppressive therapy was conducted at five tertiary uveitis clinics between 1995 to 2008. Demographic and clinical characteristics were abstracted by chart review of every visit, including dose and duration of mycophenolate, inflammatory activity, doses of oral corticosteroid therapy, frequency of discontinuation, and reasons for discontinuation. Survival analysis was used to analyze success in controlling inflammation, corticosteroid-sparing success (maintaining control of inflammation with prednisone ≤10 mg/day), and time-to-discontinuation of mycophenolate mofetil.

Results: : Of the 289 patients( 497 eyes) treated initiating mycophenolate mofetil therapy,16.6%,12.1% and 43.6% had anterior uveitis, intermediate uveitis and posterior/panuveitis respectively;15.6% had scleritis;6.9% had mucous membrane pemphigoid; and 5.2% had other ocular inflammatory diseases. Complete control of inflammation sustained over consecutive visits spanning ≥28 days was achieved in ≤6 months in 55.2%, 46%, 33.1%, 32.8%, and 37.4% of patients with anterior uveitis, intermediate uveitis, posterior/panuveitis, scleritis, and ocular mucous membrane pemphigoid respectively. The drug was discontinued in 103 patients.Failure to control inflammation (25 patients 24%) and side effects due to mycophenolate (24 patients, 23%) were the most common causes for discontinuation. Adverse side effects were typically reversible with dose adjustment or drug discontinuation.

Conclusions: : Mycophenolate mofetil was well-tolerated and effective for the management of anterior uveitis and mucous membrane pemphigoid. Therapeutic success was appreciable but less frequent for scleritis, intermediate uveitis and posterior or panuveitis although "success" rates would have been higher with a more liberal definition.

Keywords: uveitis-clinical/animal model • clinical (human) or epidemiologic studies: outcomes/complications • drug toxicity/drug effects