Non-infectious Ocular Inflammatory Disease: Mycophenolate Vs Methotrexate

Pavankumar Kamat

Disclosures

March 07, 2022

Takeaway

  • Mycophenolate mofetil (MMF) and methotrexate (MTX) did not differ in the overall treatment success and failure at 6 months in non-infectious ocular inflammatory disease (NIOID).

  • MTX was associated with a better success rate in posterior and panuveitis cases.

Why This Matters

  • Further studies are warranted to determine the comparative effectiveness of both MTX and MMF in treating NIOID and to investigate whether the effectiveness varies depending on the anatomical subtype of uveitis.

Study Design

  • Meta-analysis of 4 studies including 905 patients with NIOID, identified after a search across electronic databases.

  • Primary outcomes: treatment outcomes and side effects.

  • Secondary outcomes: changes in visual acuity and resolution of macular oedema.

  • Funding: None.

Key Results

  • No significant difference was seen between the MMF and MTX groups in (OR; 95% CI):

    • overall treatment success (0.97; 0.32 to 2.92; P=0.96); and

    • treatment failure (0.86; 0.18 to 4.10; P=0.85; I2, 93% for both).

  • Treatment success rates of posterior uveitis and panuveitis were higher with MTX (OR 0.41; 95% CI 0.23 to 0.74; P=0.003).

  • The MMF vs MTX group was associated with a faster median time to reach treatment success and had fewer side effects, but the difference was not significant.

  • There was no significant difference in visual acuity and resolution of macular oedema between the 2 groups.

Limitations

  • Heterogeneity among studies.

Karam M, Alsaif A, Al-Naseem A, Hayre A, Al Jabbouri A, Aldubaikhi A, Kahlar N, Al-Mutairi S. Mycophenolate versus Methotrexate in Non-infectious Ocular Inflammatory Disease: A Systematic Review and Meta-Analysis. Ocul Immunol Inflamm. 2022 Feb 24 [Epub ahead of print]:1-8. doi: 10.1080/09273948.2022.2034166. PMID: 35201968 View abstract.

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