Risk of failing both methotrexate and mycophenolate mofetil from the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial.
Immunomodulatory therapy
Methotrexate
Mycophenolate mofetil
Non-infectious uveitis
Retinal vasculitis
Journal
Journal of ophthalmic inflammation and infection
ISSN: 1869-5760
Titre abrégé: J Ophthalmic Inflamm Infect
Pays: Germany
ID NLM: 101553216
Informations de publication
Date de publication:
09 Jun 2023
09 Jun 2023
Historique:
received:
09
11
2022
accepted:
20
05
2023
medline:
9
6
2023
pubmed:
9
6
2023
entrez:
9
6
2023
Statut:
epublish
Résumé
The antimetabolites methotrexate (MTX) and mycophenolate mofetil (MMF) are commonly used as initial corticosteroid-sparing treatment for uveitis. There is little data examining risk factors for failing both MTX and MMF. The objective of this study is to determine risk factors for failing both MTX and MMF in patients with non-infectious uveitis. This is a sub-analysis of the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial, which was an international, multicenter, block-randomized, observer-masked, comparative effectiveness trial comparing MTX and MMF as initial treatments for non-infectious uveitis. This study was undertaken at multiple referral centers in India, the United States, Australia, Saudi Arabia and Mexico between 2013 and 2017. A total of 137 patients who completed all 12 months of follow-up from the FAST trial, were included in this study. The primary outcome was failing both antimetabolites over the 12 months of the trial. Potential predictors included: age, sex, bilateral involvement, anatomic location of the uveitis, presence of cystoid macular edema (CME) and retinal vasculitis at baseline visit, uveitis duration, and country/study sites as risk factors for failing both MTX and MMF. The presence of retinal vasculitis posterior to the equator on fluorescein angiogram was associated with failing both MTX and MMF. Retinal vasculitis may be a risk factor for failing multiple antimetabolites. Clinicians could consider more quickly advancing these patients to other medication classes, such as biologics.
Sections du résumé
BACKGROUND
BACKGROUND
The antimetabolites methotrexate (MTX) and mycophenolate mofetil (MMF) are commonly used as initial corticosteroid-sparing treatment for uveitis. There is little data examining risk factors for failing both MTX and MMF. The objective of this study is to determine risk factors for failing both MTX and MMF in patients with non-infectious uveitis.
MAIN BODY
METHODS
This is a sub-analysis of the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial, which was an international, multicenter, block-randomized, observer-masked, comparative effectiveness trial comparing MTX and MMF as initial treatments for non-infectious uveitis. This study was undertaken at multiple referral centers in India, the United States, Australia, Saudi Arabia and Mexico between 2013 and 2017. A total of 137 patients who completed all 12 months of follow-up from the FAST trial, were included in this study. The primary outcome was failing both antimetabolites over the 12 months of the trial. Potential predictors included: age, sex, bilateral involvement, anatomic location of the uveitis, presence of cystoid macular edema (CME) and retinal vasculitis at baseline visit, uveitis duration, and country/study sites as risk factors for failing both MTX and MMF. The presence of retinal vasculitis posterior to the equator on fluorescein angiogram was associated with failing both MTX and MMF.
CONCLUSION
CONCLUSIONS
Retinal vasculitis may be a risk factor for failing multiple antimetabolites. Clinicians could consider more quickly advancing these patients to other medication classes, such as biologics.
Identifiants
pubmed: 37294447
doi: 10.1186/s12348-023-00350-5
pii: 10.1186/s12348-023-00350-5
pmc: PMC10256664
doi:
Types de publication
Journal Article
Langues
eng
Pagination
29Informations de copyright
© 2023. The Author(s).
Références
Retina. 2015 Dec;35(12):2641-6
pubmed: 26200508
Clin Rheumatol. 2018 Oct;37(10):2805-2809
pubmed: 29766375
Am J Ophthalmol. 2000 Oct;130(4):492-513
pubmed: 11024423
Ophthalmology. 2009 Nov;116(11):2188-98.e1
pubmed: 19748676
Ophthalmology. 2008 Aug;115(8):1416-21, 1421.e1
pubmed: 18221998
Ophthalmology. 2022 Jun;129(6):721-723
pubmed: 35085661
Ophthalmology. 2021 Jun;128(6):899-909
pubmed: 33157077
Ophthalmology. 2014 Mar;121(3):785-96.e3
pubmed: 24359625
Surv Ophthalmol. 2011 Nov-Dec;56(6):474-510
pubmed: 22117884
JAMA. 2019 Sep 10;322(10):936-945
pubmed: 31503307
Ann Rheum Dis. 2018 Jun;77(6):808-818
pubmed: 29625968
Am J Ophthalmol. 2010 Mar;149(3):423-32.e1-2
pubmed: 20042178