Methotrexate and mycophenolate provide equally efficient control of uveitis

This subanalysis of the First-line Antimetabolites as Steroid-sparing Treatment (FAST) trial, a multicenter, randomized trial comparing methotrexate and mycophenolate mofetil in noninfectious uveitis (NIU), focused on time to corticosteroid-sparing control of inflammation.

Study design

A total of 216 patients aged ≥16 years with intermediate uveitis, posterior uveitis, or panuveitis were enrolled in FAST; 194 patients completed follow-up through the 6-month primary endpoint and were included in the subanalysis. The primary endpoint of treatment success was defined as control of inflammation in both eyes, the use of 7.5 mg prednisone and ≤2 drops of prednisolone acetate 1% daily, and no prior treatment failure.

Outcomes

In the primary FAST trial analysis, outcomes were similar between the methotrexate and mycophenolate mofetil groups. Comparable results were seen in this subanalysis: there was no significant difference in time to reach a corticosteroid-sparing prednisone dose (7.5 mg/day) between the 2 groups (125 days for the methotrexate group and 133 days for the mycophenolate mofetil group). In patients who achieved treatment success, the median prednisone dose was 18.2 mg/day in those given methotrexate and 17.7mg/day in those given mycophenolate mofetil.

Limitations

One limitation of the study was that it was a subanalysis of a randomized trial and one that was powered to detect differences in effectiveness between the two medications but was not powered for corticosteroid exposure.

Clinical significance

The results of this subanalysis show that there was no difference in time to corticosteroid-sparing control between methotrexate and mycophenolate.