• Uveitis

    A subanalysis of the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial focused on outcomes in the subgroup of patients with uveitic macular edema.

    Study design

    The block-randomized, observer-masked, multicenter First-line Antimetabolites as Steroid-sparing Treatment (FAST) clinical trial compared methotrexate 25 mg weekly and mycophenolate mofetil (MMF) 1.5 g twice weekly, with corticosteroid taper for the treatment of patients with uveitis. Investigators analyzed outcomes of eyes with uveitic macular edema at 6 and 12 months. If the prespecified primary outcome (treatment success) wasn't achieved at 6 months, patients were switched to the other treatment group.

    Outcomes

    Forty-two eyes of 30 patients in the methotrexate group and 55 eyes of 41 patients in the MMF group had uveitic macular edema. Of that population, at the 12-month timepoint 42% of the methotrexate-treated eyes and 60% of the MMF-treated eyes had some improvements in uveitic macular edema; however, 63% of eyes in patients given methotrexate and 40% of eyes in patients given MMF had not achieved complete resolution by 12 months.

    Limitations

    The FAST uveitis trial included patients with a range of uveitic conditions and did not tailor to or group outcomes by any specific type. Local steroids were also allowed, which could confound outcomes. The main study was designed with control of inflammation as the primary outcome, rather than resolution of uveitic macular edema.

    Clinical significance

    Treatment with either methotrexate or MMF appears to improve uveitic macular edema with similar results. Because a large percentage of cases remained after 12 months, additional treatment beyond that timeframe may be required.