Comparison Between Methotrexate and Mycophenolate Mofetil Monotherapy for the Control of Noninfectious Ocular Inflammatory Diseases.
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Female
Glucocorticoids
/ therapeutic use
Humans
Immunosuppressive Agents
/ therapeutic use
Infant
Inflammation
/ drug therapy
Male
Methotrexate
/ therapeutic use
Middle Aged
Mycophenolic Acid
/ therapeutic use
Prednisone
/ therapeutic use
Retrospective Studies
Scleritis
/ drug therapy
Uveitis
/ drug therapy
Visual Acuity
/ physiology
Journal
American journal of ophthalmology
ISSN: 1879-1891
Titre abrégé: Am J Ophthalmol
Pays: United States
ID NLM: 0370500
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
18
06
2018
revised:
13
07
2019
accepted:
13
07
2019
pubmed:
26
7
2019
medline:
28
3
2020
entrez:
26
7
2019
Statut:
ppublish
Résumé
To compare mycophenolate mofetil (MMF) to methotrexate (MTX) as corticosteroid-sparing therapy for ocular inflammatory diseases. Retrospective analysis of cohort study data. Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics were obtained via medical record review. The study included 352 patients who were taking single-agent immunosuppression with MTX or MMF at 4 tertiary uveitis clinics. Marginal structural models (MSM)-derived statistical weighting created a virtual population with covariates and censoring patterns balanced across alternative treatments. With this methodological approach, the results estimate what would have happened had none of the patients stopped their treatment. Survival analysis with stabilized MSM-derived weights simulated a clinical trial comparing MMF vs MTX for noninfectious inflammatory eye disorders. The primary outcome was complete control of inflammation on prednisone ≤10 mg/day, sustained for ≥30 days. The time to success was shorter (more favorable) for MMF than MTX (hazard ratio = 0.68, 95% confidence interval: 0.46-0.99). Adjusting for covariates, the proportion achieving success was higher at every point in time for MMF than MTX from 2 to 8 months, then converges at 9 months. The onset of corticosteroid-sparing success took more than 3 months for most patients in both groups. Outcomes of treatment (MMF vs MTX) were similar across all anatomic sites of inflammation. The incidence of stopping therapy for toxicity was similar in both groups. Our results suggest that, on average, MMF may be faster than MTX in achieving corticosteroid-sparing success in ocular inflammatory diseases.
Identifiants
pubmed: 31344346
pii: S0002-9394(19)30331-9
doi: 10.1016/j.ajo.2019.07.008
pmc: PMC6889035
mid: NIHMS1535454
pii:
doi:
Substances chimiques
Glucocorticoids
0
Immunosuppressive Agents
0
Mycophenolic Acid
HU9DX48N0T
Prednisone
VB0R961HZT
Methotrexate
YL5FZ2Y5U1
Types de publication
Comparative Study
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
68-75Subventions
Organisme : NEI NIH HHS
ID : R01 EY014943
Pays : United States
Organisme : NEI NIH HHS
ID : R21 EY026717
Pays : United States
Organisme : NEI NIH HHS
ID : R56 EY014943
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.
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