Mycophenolate Mofetil for Ocular Inflammation

Ebenezer Daniel, Jennifer E. Thorne, Craig W. Newcomb, Siddharth S. Pujari, R. Oktay Kaçmaz, Grace A. Levy-Clarke, Robert B. Nussenblatt, James T. Rosenbaum, Eric B. Suhler, C. Stephen Foster, Douglas A. Jabs, John H. Kempen

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Abstract

Purpose: To evaluate mycophenolate mofetil as a single noncorticosteroid immunosuppressive treatment for noninfectious ocular inflammatory diseases. Design: Retrospective cohort study. 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.

Original languageEnglish (US)
Pages (from-to)423-432.e2
JournalAmerican journal of ophthalmology
Volume149
Issue number3
DOIs
StatePublished - Mar 2010

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ASJC Scopus subject areas

  • Ophthalmology

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Daniel, E., Thorne, J. E., Newcomb, C. W., Pujari, S. S., Kaçmaz, R. O., Levy-Clarke, G. A., Nussenblatt, R. B., Rosenbaum, J. T., Suhler, E. B., Foster, C. S., Jabs, D. A., & Kempen, J. H. (2010). Mycophenolate Mofetil for Ocular Inflammation. American journal of ophthalmology, 149(3), 423-432.e2. https://doi.org/10.1016/j.ajo.2009.09.026