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Mycophenolate Mofetil Therapy for Inflammatory Eye Disease

¹ Ophthalmology, The Wilmer Eye Institute, Baltimore, MD
² Ophthalmology, Royal Preston Hospital, Preston, United Kingdom

Commercial Relationships: J.E. Thorne, None; D.A. Jabs, None; F.A. Qazi, None; Q.D. Nguyen, None; J.P. Dunn, None; J.H. Kempen, None.

Support: NIH Grants EY–13707 (Dr. Thorne), EY–00405 (Dr. Jabs), and EY–14943 (Dr. Kempen)

Abstract

Purpose: To assess outcomes of treatment with mycophenolate mofetil (Cellcept, Roche, Nutley, NJ) in patients with inflammatory eye disease.

Methods: The medical records of 84 consecutive patients with inflammatory eye disease seen at a single medical institution from January 1998 to June 2004 were retrospectively reviewed for treatment with mycophenolate mofetil. Doses of mycophenolate mofetil and of prednisone, response to therapy, use of other immunosuppressive drugs, and mycophenolate mofetil–related side effects were recorded. "Treatment success" was defined as the ability to control ocular inflammation with mycophenolate mofetil and to taper prednisone to < 10 mg daily.

Results: Of the 84 patients treated with mycophenolate mofetil, 61% had uveitis, 17% had scleritis, 11% had mucous membrane pemphigoid, and 11% had orbital or other inflammatory disease. Eighty–nine percent of the patients had bilateral disease, and 84% of the affected eyes had one or more ocular complications from their inflammatory disease at the start of treatment with mycophenolate mofetil. The median duration of inflammatory disease at the start of mycophenolate therapy was 21 months. Forty–three percent of patients were treated with at least one other immunosuppressive drug previous to the institution of mycophenolate mofetil therapy. The median dose of prednisone at the start of mycophenolate mofetil therapy was 40 mg. Eighty–two percent of the patients were considered a treatment success as judged by the ability to control the inflammation and taper the prednisone to less than 10 mg daily. The median time to treatment success was 3.5 months. The rate for discontinuing prednisone was 0.58/person–year (PY) in those patients with treatment success. Mycophenolate mofetil therapy was discontinued due to ineffectiveness at a rate of 0.10/PY and due to side effects at a rate of 0.08/PY. The most frequent side effect was gastrointestinal upset with a rate of 0.19/PY.

Conclusions: These data suggest that mycophenolate mofetil may be an effective corticosteroid–sparing agent in the treatment of inflammatory eye disease with a reasonable side effect profile.

Keywords: immunomodulation/immunoregulation

© 2005, The Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any part of this abstract, contact the ARVO Office at arvo{at}arvo.org.