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Impressum
Efficacy of mycophenolate mofetil in the management of uveitis
Greiner K., Varikkara M., Forrester J. V.
Dept. of Ophthalmology, Grampian University Hospitals, Aberdeen, UK
Objective: The severity of disease and the side effects of long-term
corticosteroid treatment support the rationale for other immunosuppressive
drugs in the management of uveitis. Mycophenolate mofetil (MMF) is a selective
inhibitor of ionosine monophosphate dehydrogenase and exerts its major
effects in T and B lymphocytes. This study was undertaken to evaluate
the immunomodulatory effect of MMF in the control of intermediate and
posterior uveitis.
Methods: A retrospective study of 18 consecutive patients with
intermediate or posterior uveitis treated with MMF was performed. Activity
of intraocular inflammation was graded according to the guidelines of
the international uveitis study group (anterior chamber activity, bioscore,
active inflammatory lesions, macular edema) before and during treatment
with MMF. Furthermore, the ability of MMF treatment to reduce the steroid
dosage and / or substitute other immunosuppressive agents with unacceptible
side effects (cyclosporin A, tacrolimus, azathioprine) was evaluated.
Results: The indication for treatment with MMF in all 18 patients
(age range: 13-76 years) was either poor control of ocular inflammation
by their previous immunosuppressive therapy or unacceptible side effects
of this therapy. The daily MMF dose was 1 - 2.5 g adjusted to the inflammatory
activity in each patient. MMF was replacing cyclosporin or other immunosuppressive
therapy in 11 patients and was added on as additional therapy in 7 patients.
Steroid dosage could be reduced in 6 patients following MMF therapy. Marked
resolution of ocular inflammatory activity occurred in 13 patients. The
most frequently observed side effects of MMF were myalgia, fatigue, headache
and gastrointestinal problems (nausea, vomiting).
Conclusion: MMF was effective in disease control in the majority
of patients with intermediate and posterior uveitis and proved to be a
useful second line immunosuppressant for refractory intraocular inflammatory
disease with an acceptible profile of side effects.