Mycophenolate mofetil in the treatment of uveitis in children

Abstract

Background: Mycophenolate mofetil (MMF) is a new immunosuppressive agent that effectively controls the intraocular inflammation in adults. Purpose: To assess the efficacy of MMF in uveitis in children and to analyse the possible side effects. Participants and methods: A retrospective analysis was carried out on 17 children (32 eyes) with intraocular inflammation treated with MMF and followed up at the University Eye Hospital Tuebingen, Tuebingen, Germany, between 2000 and 2005. All children had chronic non-infectious uveitis and received MMF for at least 6 months. All patients were given steroids or other immunosuppressive agents before initiating treatment with MMF. Results: 17 children (10 boys and 7 girls) with a mean age of 8 (range 2-13) years at the onset of uveitis were examined. The average duration of follow-up after initiation of MMF was 3 (range 2-5) years. A steroid-sparing effect was achieved in 88% of the patients. The oral prednisolone was successfully discontinued in 41% children and reduced to a daily dose of (5 mg in 47% of the children. 24% of the patients remained relapse-free during the treatment, but a reduction in the relapse rate was observed in all other patients except one. Visual acuity was increased or maintained in 13 children (76%). Mild side effects (headache, rash, gastrointestinal discomfort) occurred in 7 patients (41%) and were the cause of discontinuation of MMF in 1 patient. Conclusion:The results of our study are encouraging and suggest that MMF is an effective agent also in the treatment for uveitis in children, with marked steroid-sparing potential and an acceptable side effect profile.

Mycophenolate mofetil monotherapy in the management of paediatric uveitis

“…[23][24][25][26][27][28] The results of these studies, however, do not specifically address the effectiveness and safety of MMF in children. Before the present report, the effectiveness of MMF exclusively in treatment of paediatric uveitis had only been demonstrated in the case series study of 17 children conducted by Doycheva et al 29 In support of that previous work, our data suggest that MMF monotherapy is an effective steroid-sparing treatment in paediatric autoimmune uveitis. Approximately half of our patients (25/52, or 48.1%) met our definition of Durable Disease Control; another nine patients had gained excellent inflammation control at the last follow-up, although they had yet to meet the 2-year mark; finally, four patients were able to achieve inflammation control on MMF monotherapy, although they had to discontinue the medication subsequently because of significant adverse effects.…”

“…[23][24][25][26][27][28][29][30] In the present study, it took about 5 months to develop these adverse effects while on MMF therapy. In about one-fifth of the study population, the adverse effects were significant, but a decrease in MMF dosage was able to bring the effects under control in approximately half of these patients.…”

Abatacept for severe anti–tumor necrosis factor α refractory juvenile idiopathic arthritis–related uveitis

“…Despite improvements in the treatment strategy for arthritis, less progress has been made in the treatment of uveitis, which remains one of the greatest challenges encountered by pediatric rheumatologists and ophthalmologists. Although first-line treatment for uveitis consists of topical and oral steroids with methotrexate (MTX) for more severe uveitis (2), treatment with cyclosporin A (CSA) (3), mycophenolate mofetil (MMF) (4), and, more recently, anti-tumor necrosis factor (anti-TNF) agents such as infliximab (5) and adalimumab (6), has been proposed.…”

Treatment Approach for Juvenile Idiopathic Arthritis-Related Uveitis: 2012 Update

“…Исследования применения препарата у детей, стра-дающих увеитом, показали, что ММФ позволяет сни-зить потребность в гормональной терапии у большинства пациентов, однако лишь у некоторых из них не отмеча-ется рецидивов, в то время как у значительной части наблюдаемых улучшалась острота зрения или не реги-стрировалось ее ухудшения [26,27]. Побочные эффекты легкой степени выраженности, как, например, голов-ная боль, кожные высыпания и дискомфорт со стороны желудочно-кишечного тракта, были зарегистрированы приблизительно у 40% пациентов.…”