Mycophenolate mofetil may be effective for ocular inflammation

Researchers reviewed the charts of 236 patients (397 eyes) with noninfectious ocular inflammation treated with mycophenolate mofetil  (MM) at four subspecialty clinics from 1995 to 2007. Most patients had uveitis (20.3 percent, 11.9 percent, and 39.8 percent had anterior uveitis, intermediate uveitis, and posterior uveitis or panuveitis, respectively), with the remaining suffering from scleritis,mucous membrane pemphigoid or some other ocular inflammatory disease.

Within on one year, 73 percent of patients achieved complete and sustained (at least 28 days) control of inflammation , with  53 percent achieving complete, sustained control  within six months.  Control was maintained  with a reduced  dosage (10 mg of prednisone or less) in 41 percent at six months, and in 55 percent of patients at one year.  Within the year,  12 percent of patients discontinued treatment due to side effects. Measuring the effectiveness of a single drug for treating ocular inflammatory disorders is challenging because the mechanisms underlying the different disorders are diverse and the clinical definition of effectiveness is relative, especially when treatment often falls short of achieving complete remission.

This study supports the viewpoint that mycophenolate mofetil may have a role as the next drug to use when a few months of systemic steroids (greater than 10mg/day) fails to achieve suppression of the ocular inflammation. This antimetabolite preferentially affects lymphocytes and is less toxic to the liver than the more widely used methotrexate.  Even though it has been used for uveitis for more than 15 years, this very expensive, now generic drug, is not available to all patients because many insurance plans refuse to provide the drug for ocular inflammatory disorders. Hopefully, this study will provide evidence to the insurers of its effectiveness.