Year 7: MUST Results Support Systemic Therapy for Uveitis
Journal of the American Medical Association
Kempen et al., representing the Writing Committee for the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study Research Group, evaluated visual acuity (VA) among patients with uveitis who had received a fluocinolone acetonide implant or been treated with corticosteroids and supplementary immunosuppression. They observed that, during 7 years of monitoring, systemic therapy produced greater improvement in VA.
At earlier time points in the MUST randomized trial (at the 2-and 4.5-year marks), VA and systemic outcomes were similar for the 2 treatment groups. Nonprespecified extended monitoring of the study population was conducted to determine whether the treatment groups diverged in VA by 7 years.
In the initial trial, patients were randomly assigned to undergo systemic therapy or implant placement in at least 1 eye. For the extended follow-up study, patients were advised to continue their assigned treatment unless contraindicated. The primary outcome was change in best-corrected VA; the minimal clinically important difference for change in letters read was 7 letters. Secondary outcomes included ocular and systemic effects.
Of the 497 uveitic eyes originally enrolled in the MUST trial, 7-year follow-up data were available for 328 (approximately 70% of each treatment group). Change in VA from baseline favored systemic therapy by 7.1 letters; this difference was confirmed by sensitivity analyses. By 7 years, the proportion of patients with legal blindness decreased by 1% in the corticosteroid group but increased by 8% in the implant group. Patients with implants were more likely to experience visual impairment related to the chorioretinal lesion as well as glaucoma, cataract, and elevated intraocular pressure. Systemic therapy was associated with greater likelihood of infection requiring treatment.
The authors concluded that by 7 years of follow-up, systemic therapy is moderately superior to implantation in terms of VA. However, they said, the results should be interpreted with caution, as many patients from the original trial were lost to follow-up or received crossover treatment.
The original article can be found here.