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  • Oral antimetabolites improve quality of life in patients with uveitis

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    Review of: Health- and vision-related quality of life in a randomized controlled trial comparing methotrexate and mycophenolate mofetil for uveitis

    Kelly N, Chattopadhyay A, Rathinam S, et al. Ophthalmology, September 2021

    Using a patient population from the randomized FAST clinical trial which studied the efficacy and safety of oral methotrexate and mycophenolate mofetil for noninfectious uveitis, investigators assessed whether these antimetabolites had an effect on patient quality of life (QoL).

    Study design

    In this secondary analysis of the multinational, 4-year FAST trial, 216 participants with noninfectious uveitis were randomized 1:1 to receive either oral methotrexate 25 mg weekly or oral mycophenolate mofetil 1.5 g twice daily. Changes at 6 months (the primary endpoint) and 12 months (the secondary endpoint) in both health-related quality of life (HRQOL) and vision-related quality of life (VRQOL) were measured with the 36-item Short Form Health Survey (SF-36v2) and the National Eye Institute Visual Function Questionnaire (NEI-VRQ).

    Outcomes

    In the total population, NEI-VRQ scores improved significantly from baseline to 6 and 12 months (61.9, 81.5, and 84.0, respectively). These results were noted in the individual treatment groups as well, though greater improvement was seen in patients taking methotrexate compared with patients taking mycophenolate mofetil. In all patients, better physical and mental HRQoL was seen at 6 months post-baseline, with no significant differences noted between the treatment groups.

    Limitations

    This trial lacked a placebo control group of participants who were not currently receiving treatment for uveitis, and because the medications in this study were provided at no cost to patients, the investigators thought that this might have had an influence on the reported QoL improvement. As well, the QoL scales used in this study were not designed for use in patients specifically with uveitis.

    Clinical significance

    The antimetabolites methotrexate and mycophenolate mofetil significantly improved physical, mental, and vision-related well-being of patients with noninfectious uveitis during the course of 12 months, with both medications being equally efficacious.