RESEARCH PAPER
The first investigation on differences in the effectiveness of mycophenolate mofetil and azathioprine antimetabolites determined in Polish patients treated for non-infectious uveitis
 
More details
Hide details
1
SPKSO Ophthalmic Hospital, Warsaw, Poland
2
Department of Ophthalmology, Medical University, Warsaw, Poland
3
Department of Medical Biology, Medical University, Warsaw, Poland
4
Department of Immunology, Transplantology, and Internal Diseases, Medical University, Warsaw, Poland
CORRESPONDING AUTHOR
Lidia Chomicz   

Department of Medical Biology, Medical University of Warsaw, Litewska 14/16, 00-575, Warsaw, Poland
 
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
The non-infectious uveitis, a serious vision-threatening disease is the fourth most common cause of blindness in working population of the developed world. Various antimetabolites are applied in corticosteroid-sparing therapy also in Poland but their efficacy was not compared in our country. The aim of our study was to compare mycophenolate mofetil and azathioprine in terms of therapeutic effect of the antimetabolites in Polish patients with this disease.

Material and methods:
The comparative, retrospective study included data of 61 patients admitted to Independent Public University Eye Hospital between January 2009 and January 2017, treated with antimetabolites for non-infectious uveitis. 31 patients received mycophenolate mofetil, 30 patients – azathioprine. In the assessment of corticosteroid-sparing efficacy, among others changes in visual acuity, the duration of the disease and therapy, incidence of ophthalmologic complications, adverse systemic side effects were determined.

Results:
The corticosteroid-sparing therapy was more often effective, and an improvement of visual acuity more frequent in patients treated with mycophenolate mofetil than in these receiving azathioprine (84% patients vs. 60%, and 27% patients vs. 13%, respectively); these differences were statistically significant (p<0.05).

Conclusions:
Results of our study showing better therapeutic efficacy when applied mycophenolate mofetil seems promising approach for treatment of non-infectious posterior uveitis and panuveitis. In the first study, there was different duration of the disease before drug administration (10.5 years vs. 7.14 years in the azathioprine and mycophenolate mofetil therapy, respectively, p<0.05) and limited number of patients assessed, thus it is desirable to examine more Polish patients treated with the antimetabolites.

 
REFERENCES (41)
1.
Rothova A, Suttorp-van Schulten MS, Frits Treffers W, Kijlstra A. Causes and frequency of blindness in patients with intraocular inflammatory disease. Br J Ophthalmol. 1996; 80: 332–336.
 
2.
Murray PI, Rauz S. The eye and inflammatory rheumatic diseases: the eye and rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis. Best Pract Res Clin Rheumatol. 2016: 30: 802–825.
 
3.
Read RW, Holland GN, Rao NA, Tabbara KF, Ohno S, Arellanes-Garcia L, et al. Revised diagnostic criteria for Vogt-Koyanagi-Harada disease: report of an international committee on nomenclature. Am J Ophthalmol. 2001; 131: 647–652.
 
4.
Mendes Lavezzo M, Sakata VM, Morita C, Rodriguez EE, Abdallah SF, Silva F, et al. Vogt-Koyanagi-Harada disease: review of a rare autoimmune disease targeting antigens of melanocytes. Orphanet J Rare Dis. 2016; 11: 29.
 
5.
Silpa-archa S, Lee JJ, Foster CS. Ocular manifestations in systemic lupus erythematosus. Br J Ophthalmol. 2016 Jan; 100(1): 135–41.
 
6.
Pasadhika S, Rosenbaum JT. Ocular Sarcoidosis. Clin Chest Med. 2015 Dec; 36(4): 669–83.
 
7.
Jamilloux Y, Kodjikian L, Broussolle C, Sève P. Sarcoidosis and uveitis. Autoimmun Rev. 2014 Aug; 13(8): 840–9. doi: 10.1016/j.autrev.2014.04.001. Epub 2014 Apr 3.
 
8.
Lim LL, Scarborough JD, Thorne JE, Graham E, Kempen JH, Mackensen F, Nguyen QD, Prabriputaloong T, Read RW, Suhler EB, Schwartz JM, Smith JR. Uveitis in patients with autoimmune hepatitis. Am J Ophthalmol. 2009 Feb; 147(2): 332–338.
 
9.
Olsen TG, Frederiksen J. The association between multiple sclerosis and uveitis. Surv Ophthalmol. 2017 Jan – Feb; 62(1): 89–95. doi: 10.1016/j.survophthal.2016.07.002. Epub 2016 Aug 1.
 
10.
Messenger W, Hildebrandt L, Mackensen F, Suhler E, Becker M, Rosenbaum JT. Characterization of uveitis in association with multiple sclerosis. Br J Ophthalmol. 2015 Feb; 99(2): 205–9.
 
11.
Suttorp-Schulten MS, Rothova A. The possible impact of uveitis in blindness: a literature survey. Br J Ophthalmol. 1996: 80: 844–848.
 
12.
Biziorek B, Mackiewicz J, Zagórski Z, Krwawicz L, Haszcz D. Etiology of uveitis in rural and urban areas of mid-eastern Poland. Ann Agric Environ Med. 2001; 8(2): 241–243.
 
13.
Kwon JW, Sim Y, Jee D. Association between intermediate uveitis and toxocariasis in the Korean population. Medicine. 2017; 96: e5829.
 
14.
Zibaei M, Alemi M, Cardillo NM, Derafshi H, Miahipour A, Bahadory S, Zarei M. Human toxocariasis seroprevalence among patients with uveitis in Alborz Province, Iran. Ann Agric Environ Med. 2019; 26(1): 154–158.
 
15.
Raizman M. Corticosteroid therapy of eye disease. Fifty years later. Arch Ophthalmol. 1996; 114: 1000–1.
 
16.
Lustig J, Cunningham ET, Jr. Use of immunosuppressive agents in uveitis. Curr Opin Ophthalmol. 2003; 14: 399–412.
 
17.
Jabs DA, Rosenbaum J, Yocum D, Holland GN, Jaffe GJ, Louie JS, et al. Guidelines for the Use of Immunosuppresive Drugs in Patients with Ocular Inflammatory Disorders: recommendations of an Expert panel. Am J Ophthalmol. 2000; 130: 492–513.
 
18.
Allison AC. Mechanisms of action of mycophenolate mofetil. Lupus 2005; 14: S2–S8.
 
19.
Okada AA. Immunomodulatory therapy for ocular inflammatory disease: a basic manual and review of the literature. Ocul Immunol Inflamm. 2005; 13: 335–51.
 
20.
Radzikowska E. Pneumonia in immunocompramised patients — general clinical view. Pneumonol Alergol Pol. 2010; 78, 3: 236–243.
 
21.
Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005; 140: 509–516.
 
22.
Daniel E, Thorne JE, Newcomb CW, Pujari SS, Kaçmaz RO, Levy-Clarke GA, et al. Mycophenolate mofetil for ocular inflammation. Am J Ophthalmol. 2010; 149: 423–32.
 
23.
Pasadhika S, Kempen JH, Newcomb CW, Liesegang TL, Pujari SS, Rosenbaum JT, et al. Azathioprine for ocular inflammatory diseases. Am J Ophthalmol. 2009; 148: 500–509.
 
24.
Galor A, Jabs DA, Leder HA, Kedhar SR, Dunn JP, Peters GB, et al. Comparison of antimetabolite drugs as corticosteroid-sparing therapy for noninfectious ocular inflammation. Ophthalmology 2008; 115: 1826–32.
 
25.
Cuchacovich M, Solanes F, Perez C, Verdaguer JI, Verdaguer J, Castiglione E, Carpentier C, et al. Mycophenolate Mofetil Therapy in Refractory Inflammatory Eye Disease. J Ocul Pharmacol Ther. 2016; 32: 55–61.
 
26.
Teoh S, Hogan A, Dick A, Lee R. Mycophenolate mofetil for the Treatment of Uveitis. Am J Ophthalmol. 2008; 146: 752–760.
 
27.
Lau CH, Comer M, Lightman S: Long-term efficacy of mycophenolate mofetil in the control of severe intraocular inflammation. Clin Exp Ophthalmol. 2003; 31: 487–91.
 
28.
Joshi L, Talat L, Yaganti S, Sandhu S, Taylor S, Wakefield D, et al. Outcomes of Changing Immunosuppressive Therapy after Treatment Failure in Patients with Noninfectious Uveitis. Ophthalmol. 2014; 121(5): 1119–1124.
 
29.
Levy-Clarke G, Jabs DA, Read RW, Rosenbaum JT, Vitale A, Van Gelder RN. Expert panel recommendations for the use of anti-tumor necrosis factor biologic agents in patients with ocular inflammatory disorders. Ophthalmology. 2014; 121(3): 785–796. e3.
 
30.
Rudwaleit M, Rødevand E, Holck P, Vanhoof J, Kron M, Kary S, et al. Adalimumab effectively reduces the rate of anterior uveitis flares in patients with active ankylosing spondylitis: results of a prospective open-label study. Ann Rheum Dis. 2009; 68(5): 696–701.
 
31.
Kruh JN, Yang P, Suelves AM, Foster CS. Infliximab for the treatment of refractory noninfectious uveitis: A study of 88 patients with long-term follow-up. Ophthalmology. 2014; 121(1): 358–364.
 
32.
Jaffe GJ, Dick AD, Brézin AP, et al. Adalimumab in Patients with Active Noninfectious Uveitis. N Engl J Med. 2016; 375(10): 932–943.
 
33.
Dobner BC, Max R, Becker MD, Heinz C, Veltrup I, Heiligenhaus A, et al. A three-centre experience with adalimumab for the treatment of non-infectious uveitis. Br J Ophthalmol. 2013; 97(2): 134–138.
 
34.
Heiligenhaus A, Thurau S, Wildner G, Grajewski RS, Wildner G. Antiinflammatory treatment of uveitis with biologicals: new treatment options that reflect pathogenetic knowledge of the disease. Graefes Arch Clin Exp Ophthalmol. 2010: 248: 1531–1551.
 
35.
Yazgan S, Celik U, Işık M, Yeşil NK, Baki AE, Şahin H, et al. Efficacy of golimumab on recurrent uveitis in HLA-B27-positive ankylosing spondylitis. Int Ophthalmol. 2017 Feb; 37(1): 139–145.
 
36.
Silpa-Archa S, Oray M, Preble JM, Foster CS: Outcome of tocilizumab treatment in refractory ocular inflammatory diseases. Acta Ophthalmol. 2016; 94(6): e400–406.
 
37.
Emmi G, Talarico R, Lopalco G, Cimaz R, Cantini F, Viapiana O, et al. Efficacy and safety profile of anti-interleukin-1 treatment in Behçet’s disease: a multicenter retrospective study. Clin Rheumatol. 2016; 35(5): 1281–1286.
 
38.
Tugal-Tutkun I, Pavesio C, De Cordoue A, Bernard-Poenaru O, Gül A. Use of Gevokizumab in Patients with Behçet’s Disease Uveitis: An International, Randomized, Double-Masked, Placebo-Controlled Study and Open-Label Extension Study. Ocul Immunol Inflamm. 2018; 25: 1–11.
 
39.
Heiligenhaus A, Miserocchi E, Heinz C, Gerloni V, Kotaniemi K. Treatment of severe uveitis associated with juvenile idiopathic arthritis with anti-CD20 monoclonal antibody (rituximab). Rheumatology (Oxford). 2011; 50(8): 1390–1394.
 
eISSN:1898-2263
ISSN:1232-1966