Comparison Between Methotrexate and Mycophenolate Mofetil Monotherapy for the Control of Noninfectious Ocular Inflammatory Diseases - 28/11/19

Doi : 10.1016/j.ajo.2019.07.008

Sapna S. Gangaputra ^a,^b,^⁎ , Craig W. Newcomb ^c, Marshall M. Joffe ^c, Kurt Dreger ^e, Hosne Begum ^e, Pichaporn Artornsombudh ^d,^f,^g,^h, Siddharth S. Pujari ^d,^f,ⁱ, Ebenezer Daniel ^d, H. Nida Sen ^b, Eric B. Suhler ^j,^k, Jennifer E. Thorne ^e,^l, Nirali P. Bhatt ^d, C. Stephen Foster ^f,^m, Douglas A. Jabs ^l,ⁿ, Robert B. Nussenblatt ^b,^{^{†
Deceased.}}, James T. Rosenbaum ^j,^o,^p, Grace A. Levy-Clarke ^q, John H. Kempen ^m,^r,^s
and the
SITE Cohort Research Group
^a Vanderbilt Eye Institute, Nashville, Tennessee, USA
^b Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
^c Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
^d Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
^e Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
^f Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
^g Department of Ophthalmology, Somdech Phra Pinkloa Hospital, Royal Thai Navy, Bangkok, Thailand
^h Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand
ⁱ Siddharth Netralaya, Belgaum, Karnataka, India
^j Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA
^k Portland Veteran's Affairs Medical Center, Portland, Oregon, USA
^l Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
^m Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
ⁿ Departments of Ophthalmology and Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
^o Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
^p Legacy Devers Eye Institute, Portland, Oregon, USA
^q The Tampa Bay Uveitis Center, St. Petersburg, Florida, USA
^r Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
^s MCM Eye Unit/Ophthalmology, MyungSung Christian Medical Center and MyungSung Medical School, Addis Ababa, Ethiopia

^∗Inquiries to Sapna S. Gangaputra, Vanderbilt Eye Institute, 2311 Pierce Ave, Suite 2251, Nashville, TN 37232, USAVanderbilt Eye Institute2311 Pierce AveSuite 2251NashvilleTN37232USA

Abstract

Purpose

To compare mycophenolate mofetil (MMF) to methotrexate (MTX) as corticosteroid-sparing therapy for ocular inflammatory diseases.

Design

Retrospective analysis of cohort study data.

Methods

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.

Results

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.

Conclusions

Our results suggest that, on average, MMF may be faster than MTX in achieving corticosteroid-sparing success in ocular inflammatory diseases.

Le texte complet de cet article est disponible en PDF.

Plan

Methods

Application of Marginal Structural Models to Methotrexate vs Mycophenolate Mofetil

Results

Discussion

Supplemental Material available at AJO.com.

Export

Vol 208

P. 68-75 - décembre 2019 Retour au numéro

Article précédent

The Effect of a Spectral Filter on Visual Quality in Patients with an Extended-Depth-Of-Focus Intraocular Lens
Grzegorz ?abuz, Gerd U. Auffarth, Aydin Özen, Thomas J.T.P. van den Berg, Timur M. Yildirim, Hyeck-Soo Son, Ramin Khoramnia

| Article suivant

Preoperative Risk Assessment for Progression to Descemet Membrane Endothelial Keratoplasty Following Cataract Surgery in Fuchs Endothelial Corneal Dystrophy
Francisco Arnalich-Montiel, David Mingo-Botín, Pablo De Arriba-Palomero

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

connectez-vous ou créez un compte

Comparison Between Methotrexate and Mycophenolate Mofetil Monotherapy for the Control of Noninfectious Ocular Inflammatory Diseases - 28/11/19

Abstract

Purpose

Design

Methods

Results

Conclusions

Plan

Export citations

Fichier

Contenu

Accès rapides

Mon compte

Aide & support

Plateformes Elsevier Masson

Déclaration CNIL