Original article
Mycophenolate Mofetil for Ocular Inflammation

https://doi.org/10.1016/j.ajo.2009.09.026Get rights and content

Purpose

To evaluate mycophenolate mofetil as a single noncorticosteroid immunosuppressive treatment for noninfectious ocular inflammatory diseases.

Methods

Characteristics of patients with noninfectious ocular inflammation treated with mycophenolate mofetil at 4 subspecialty clinics from 1995 to 2007 were abstracted by expert reviewers in a standardized chart review of every eye at every visit. Main outcomes measured were control of inflammation, corticosteroid-sparing effects, and discontinuation of mycophenolate mofetil (including the reasons for discontinuation). Survival analysis was used to estimate the incidence of outcomes, and to identify risk factors for each.

Results

Among 236 patients (397 eyes) treated with mycophenolate mofetil monotherapy, 20.3%, 11.9%, and 39.8% had anterior uveitis, intermediate uveitis, and posterior uveitis or panuveitis respectively; 14% had scleritis; 7.6% had mucous membrane pemphigoid; and 6.4% had other ocular inflammatory diseases. By Kaplan-Meier estimation, complete control of inflammation—sustained over consecutive visits spanning at least 28 days—was achieved in 53% and 73% of patients within 6 months and 1 year respectively. Systemic corticosteroid dosage was reduced to 10 mg of prednisone or less, while maintaining sustained control of inflammation, in 41% and 55% of patients in 6 months and 1 year respectively. Twelve percent of patients discontinued mycophenolate mofetil within the first year because of side effects of therapy.

Conclusions

Given sufficient time, mycophenolate mofetil was effective in managing ocular inflammation in approximately half of the treated patients. Treatment-limiting side effects were observed in 12% of patients and typically were reversible.

Section snippets

Study Population

All patients with noninfectious ocular inflammatory disease who had started receiving treatment with mycophenolate mofetil during the study as the sole noncorticosteroid immunosuppressive agent at 3 ocular immunology and uveitis clinics and an approximate 40% random sample of such patients from a fourth center were selected to be the study population. This group of patients was nested within a larger study, the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study, the methods

Results

During follow-up, 236 patients started mycophenolate mofetil as a single (noncorticosteroid) immunosuppressive treatment. Their characteristics at the time when mycophenolate mofetil was started are given in Table 1. The median age was 47.1 years (range, 8.1–84.2 years); 64% were female and 67% were Caucasian. The mean duration of inflammation prior to starting mycophenolate mofetil was 3 years. Bilateral involvement was present in 68% of patients; 130 patients (32.7%) had a visual acuity of

Discussion

The effectiveness of mycophenolate mofetil for ocular inflammation has been reported in 3 prior medium-sized cohort reports,11, 12, 14 which differed from our methodology by including patients on combination immunosuppression in their series, and by not requiring that control of inflammation be sustained before counting a patient as achieving corticosteroid-sparing success. Among 73 patients who received mycophenolate mofetil as therapy for ocular inflammation, corticosteroid-sparing success

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