Overall, 64 patients given methotrexate (67%) and 56 of those given mycophenolate (57%) achieved treatment success at 6 months. Treatment success included inflammation control defined as “less than or equal to 0.5+ anterior chamber cells by Standardization of Uveitis Nomenclature criteria, less than or equal to 0.5+ vitreous haze clinical grading using the National Eye Institute scale, and no active retinal or choroidal lesions,” as well as needing no more than 7.5 mg of prednisone daily and two drops or less of prednisolone acetate 1% per day, and reporting no intolerability or safety concerns requiring study discontinuation.
Adverse events were similar between the groups. The most common nonserious adverse events were fatigue and headaches, and the most common nonserious laboratory adverse event was elevated liver enzymes. Fourteen serious adverse events occurred during the study period; three in the methotrexate group and two in the mycophenolate group were deemed drug related and all were elevated liver function tests.
The study findings had several limitations, including lack of masking of the patients to the medication and an inability to compare between types of uveitis, the researchers noted. Avenues for further research include whether one of the drugs is more effective based on the uveitis subtype, they added.
The study was supported in part by the National Eye Institute and study drugs were provided by the University of California San Francisco Pharmacy. Dr. Rathinam disclosed grants from Aravind Eye Hospital, and several coauthors disclosed relationships with AbbVie, Allergan, Novartis, Novotech, and Bayer.
SOURCE: Rathinam SR et al. JAMA. 2019;322(10):936-45.