title: Mycophenolate mofetil as an immunosuppressive agent in refractory inflammatory eye disease.
abstract: OBJECTIVE
  The aim of this study was to assess the role of mycophenolate mofetil (MMF) in refractory inflammatory eye disease.
  
  
  METHODS
  Retrospective, noncomparative, interventional case series of all patients commenced on MMF between 1999 and 2005 for refractory inflammatory eye disease at St Paul's Eye Unit (Liverpool, UK). Main outcome measures noted were control of inflammation, steroid-sparing effect, and adverse effects of MMF therapy.
  
  
  RESULTS
  Ten (10) patients (2 with sarcoid, 2 with intermediate uveitis, 1 with Vogt-Koyanagi Harada (VKH) syndrome, 1 with ankylosing spondylitis, 1 with juvenile chronic arthritis (JCA), and 3 with scleritis) who were unresponsive or intolerant to previous therapy and/or as a steroid-sparing agent, received 2-3 g of MMF per day for a mean period of 40.5 months (range, 3-67). Nine (9) patients had a favorable response, with diarrhea and insomnia being the main side-effects. MMF had to be withdrawn in 1 patient because of side-effects and in another because of active arthropathy (with stable uveitis). Average number of relapses was reduced from 3.1 per patient per year to 0.8 per patient per year (P < 0.005). A steroid-sparing effect was achieved in all patients. Visual acuity improved in 8 patients.
  
  
  CONCLUSIONS
  MMF appears to be a safe and effective second- or third-line adjunct/alternative immunosuppressant in these difficult cases and works well in combination with cyclosporin A, tacrolimus, and antitumor necrosis factor (TNF) agents. It has potential as a firstor second-line agent and can be considered at a dose of 3 g/day in refractory cases.
authors.affiliation: St. Paul's Eye Unit, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK. a.choudhary@liverpool.ac.uk
authors.forename: Anshoo
authors.initials: A
authors.lastname: Choudhary
authors.forename: Simon P
authors.initials: SP
authors.lastname: Harding
authors.forename: Roger C
authors.initials: RC
authors.lastname: Bucknall
authors.forename: Ian A
authors.initials: IA
authors.lastname: Pearce
mesh_terms: D000328:Adult; D000368:Aged; D009877:Endophthalmitis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid