Artikel
Mycophenolate mofetil (MMF, CellCept®) is a highly effective and safe immunosuppressive agent for the treatment of uveitis
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Autoren
Veröffentlicht: | 22. September 2004 |
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Gliederung
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Objective
We evaluated the outcomes of patients with different forms of chronic uveitis treated with MMF as an immunomodulatory and steroid-sparing agent. The multi-system side effects that arise after long-term treatment with corticosteroids and other immunosuppressants prompted us to use MMF. MMF is a selective inhibitor of ionosine monophosphate dehydrogenase thus blocking purine synthesis via the de novo pathway preferentially used by T and B lymphocytes.
Methods
Between 1998 and 2003, 106 patients were treated for uveitis (anterior n=26, intermediate n=51, posterior n= 23, panuveitis n=6). Treatment duration was between 1 and 3 years. Patient charts were analysed according to a standardized evaluation protocol.
Results
In 95 patients MMF was combined with Prednisolone in a dosage of between 2.5 to 10 mg/day. In 8 patients MMF was used as a monotherapy and in 3 cases one further systemic immunosuppressant was required. The frequency of recurrences was 1 or less in 92 patients, 2 in 6 cases and 3 or greater in 8 patients. The most frequently observed side effects were gastrointestinal upset (15%, followed by eczema (9.3%), fatigue (5.7%), headache (5%), and hair loss (3.5%). Other side effects were sporadic. Most of these phenomena were transitory. Serum cholesterol and GPT were slightly raised in 5 patients requiring reduction of the therapeutic dosage of MMF. 42 patients experienced no side effects at all. In 4 patients MMF was judged ineffective due to recurrences or persistent macular edema. In 95 patients MMF was combined with Prednisolone in a dosage of between 2.5 to 10 mg/day. In 8 patients MMF was used as a monotherapy and in 3 cases one further systemic immunosuppressant was required. The frequency of recurrences was 1 or less in 92 patients, 2 in 6 cases and 3 or greater in 8 patients. The most frequently observed side effects were gastrointestinal upset (15%, followed by eczema (9.3%), fatigue (5.7%), headache (5%), and hair loss (3.5%). Other side effects were sporadic. Most of these phenomena were transitory. Serum cholesterol and GPT were slightly raised in 5 patients requiring reduction of the therapeutic dosage of MMF. 42 patients experienced no side effects at all. In 4 patients MMF was judged ineffective due to recurrences or persistent macular edema.
Conclusions
MMF is a safe, effective immunosuppressant in patients with uveitis. We provide evidence that MMF controls the disease in the majority of patients with an acceptable profile of side effects.