Document Detail


Mycophenolate mofetil after methotrexate failure or intolerance in the treatment of scleritis and uveitis.
MedLine Citation:
PMID:  18221998     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To evaluate the outcomes of treatment with mycophenolate mofetil in patients with scleritis and uveitis refractory to or intolerant of methotrexate.
DESIGN: Retrospective noncomparative case series.
PARTICIPANTS: Eighty-five patients with scleritis and/or uveitis who failed with or did not tolerate methotrexate and were subsequently treated with mycophenolate mofetil between 1998 and 2006.
METHODS: We reviewed medical records of patients who were treated with mycophenolate mofetil after methotrexate intolerance or failure at one tertiary uveitis referral practice. We recorded dose and duration of methotrexate and mycophenolate mofetil therapy, inflammation grade, Snellen visual acuity (VA), use of other immunomodulatory therapy, and adverse events. Multivariate logistic regression was used to identify factors associated with inflammation control.
MAIN OUTCOME MEASURES: Control of inflammation, steroid-sparing effect, VA, and adverse effects were assessed.
RESULTS: Inflammation was controlled with mycophenolate mofetil in 47 patients (55%), with 5 achieving durable remission off all medication. In multivariate logistic regression analysis that adjusted for gender and age, the odds of inflammation control were lower for patients with scleritis (odds ratio [OR], 0.19; 95% confidence interval [CI], 0.04-0.93; P = 0.04) than for patients without scleritis. Among patients without scleritis, the odds of inflammation control were lower for patients with juvenile idiopathic arthritis (JIA)-associated uveitis (OR, 0.14; CI, 0.02-0.81, P = 0.03) compared to patients without JIA-associated uveitis. Eight of the 11 patients (73%) who were taking concomitant prednisone were able to taper their dose to <10 mg daily. Visual acuity declined in a greater percentage of patients who were unresponsive to mycophenolate mofetil (29%) compared with that of patients who responded to mycophenolate mofetil (9%). Side effects requiring discontinuation of mycophenolate mofetil occurred in 18 patients (21%).
CONCLUSIONS: Mycophenolate mofetil was effective in controlling inflammation in approximately half of the patients who had previously failed with or did not tolerate methotrexate. The odds of inflammation control were less in patients with the diagnoses of scleritis and JIA.
Authors:
Lucia Sobrin; William Christen; C Stephen Foster
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Publication Detail:
Type:  Journal Article     Date:  2008-01-25
Journal Detail:
Title:  Ophthalmology     Volume:  115     ISSN:  1549-4713     ISO Abbreviation:  Ophthalmology     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-08-04     Completed Date:  2008-08-19     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  7802443     Medline TA:  Ophthalmology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1416-21, 1421.e1     Citation Subset:  IM    
Affiliation:
Massachusetts Eye Research and Surgery Institute, Cambridge, Massachusetts 02142, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Child
Child, Preschool
Confidence Intervals
Female
Folic Acid Antagonists / adverse effects,  therapeutic use
Humans
Immunosuppressive Agents / adverse effects,  therapeutic use*
Male
Methotrexate / adverse effects,  therapeutic use
Middle Aged
Mycophenolic Acid / adverse effects,  analogs & derivatives*,  therapeutic use
Odds Ratio
Retrospective Studies
Scleritis / drug therapy*
Treatment Failure
Treatment Outcome
Uveitis / drug therapy*
Visual Acuity
Chemical
Reg. No./Substance:
0/Folic Acid Antagonists; 0/Immunosuppressive Agents; 24280-93-1/Mycophenolic Acid; 59-05-2/Methotrexate; 9242ECW6R0/mycophenolate mofetil

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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