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C. M. Deuter, D. Doycheva, N. Stuebiger, M. Zierhut; Mycophenolate Sodium for Immunosuppressive Treatment in Uveitis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4728.
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In several open studies mycophenolate mofetil (MMF), a pro-drug containing mycophenolic acid (MPA) as active agent, has been demonstrated as effective immunosuppressant for various inflammatory eye diseases. However, gastrointestinal side effects limited its use. Thus, an enteric-coated formulation of mycophenolate sodium (MPS) has been developed especially to reduce MPA-related gastrointestinal adverse events. The purpose of this study was to assess the efficacy and tolerability of MPS in patients with uveitis.
We performed a retrospective analysis including all uveitis patients treated with MPS (Myfortic® by Novartis) for at least 3 months duration. MPS was administered in a dose of 720 mg twice daily.
We analysed 20 consecutive patients (8 male, 12 female; mean age 44.9 years, 26-71 years). Diagnosis was anterior uveitis in 1 patient, intermediate uveitis in 12 patients, posterior uveitis in 6 patients (including 3 cases of Birdshot retinochoroidopathy and 1 case of serpiginous choroiditis) and 1 patient with panuveitis (due to Behçet's disease). Previous treatment consisted of systemic corticosteroids in all patients and at least one additional immunomodulating drug in 10 patients. Mean duration of MPS therapy was 9.4 months (3-29 months), in all patients the treatment was ongoing at the timepoint of analysis. In 19 patients MPS was given as mono immunosuppressive therapy with the addition of only low-dose corticosteroids. MPS showed effective for control of uveitis in 14 patients (70.0 %), partly effective in 4 patients (20.0 %) and ineffective in only 2 patients (10.0 %). MPS was well tolerated without side-effects in 17 patients (85.0 %). Three patients (15.0 %) developed side-effects (gastrointestinal, itching of the skin, alopecia) which discontinued in one patient after dose reduction of MPS. In another patient the MPS dose has to be halved due to increased liver enzymes.
In our series of patients MPS demonstrated as effective immunosuppressive drug for several uveitis forms. With respect to the limited number of analysed patients, the tolerability of MPS seems to be favourable compared to MMF. Thus in our opinion MPS represents a promising alternative to MMF for immunosuppressive treatment in uveitis.
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