Mycophenolate Mofetil for Ocular Inflammation

Accepted 26 September 2009. published online 30 December 2009.

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.

a The Fundus Photograph Reading Center, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

b Department of Ophthalmology, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

c Center for Clinical Epidemiology and Biostatistics, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

d Department of Biostatistics and Epidemiology, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

e Department of Ophthalmology, The Johns Hopkins University, Baltimore, Maryland

f Department of Epidemiology, The Johns Hopkins University, Baltimore, Maryland

g Massachusetts Eye Research and Surgery Institute, Cambridge, Massachusetts

h Department of Ophthalmology, St. Luke's Cataract and Laser Institute, Tarpon Springs, Florida

i Laboratory of Immunology, National Eye Institute, Bethesda, Maryland

j Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon

k Department of Medicine, Oregon Health & Science University, Portland, Oregon

l Portland Veterans' Affairs Medical Center, Portland, Oregon

m Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts

n Department of Ophthalmology, Mount Sinai School of Medicine, New York, New York

o Department of Medicine, Mount Sinai School of Medicine, New York, New York

Inquiries to John H. Kempen, MD, PhD, Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, University of Pennsylvania, 3535 Market St, Suite 700, Philadelphia, PA 19104

Supplemental Material available at AJO.com.

PII: S0002-9394(09)00739-9

doi:10.1016/j.ajo.2009.09.026

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