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Mycophenolic acid in the treatment of birdshot chorioretinopathy: long-term follow-up
  1. Deshka Doycheva1,
  2. Herbert Jägle1,2,
  3. Manfred Zierhut1,
  4. Christoph Deuter1,
  5. Gunnar Blumenstock3,
  6. Ulrich Schiefer1,4,
  7. Katarina Stingl1,
  8. Kai Januschowski1,
  9. Bogomil Voykov1,
  10. Nicole Stuebiger5
  1. 1Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
  2. 2Department of Ophthalmology, University of Regensburg, Regensburg, Germany
  3. 3Department of Clinical Epidemiology and Applied Biometry, University of Tuebingen, Tuebingen, Germany
  4. 4Competence Center “Vision Research”, Study Course “Ophthalmic Optics/Audiology”, University of Applied Sciences, Aalen, Germany
  5. 5Department of Ophthalmology, Charité, University Medicine Berlin, Berlin, Germany
  1. Correspondence to Dr Deshka Doycheva, Centre for Ophthalmology, University of Tuebingen, Schleichstr. 12, Tuebingen 72076, Germany; deshka.doycheva{at}med.uni-tuebingen.de

Abstract

Aim To assess the long-term efficacy and tolerability of both derivatives of mycophenolic acid, mycophenolate mofetil (MMF) and mycophenolate sodium (MPS), in the therapy of patients with birdshot chorioretinopathy (BSCR).

Methods Retrospective analysis of 24 patients (48 eyes) with BSCR, treated with MMF or MPS with a follow-up of at least 1 year. The main outcome measures included control of inflammation, steroid-sparing potential and side effects. Secondary outcome measure was the development of retinal function during the therapy measured by best-corrected visual acuity (BCVA), visual field and/or electroretinography (ERG).

Results Twelve patients (50%) were treated with MMF and 12 patients (50%) with MPS. Control of intraocular inflammation, defined as complete lack of clinical and angiographic signs of inflammatory activity, was achieved in 16 of 24 patients (67%). The angiographic signs of activity were significantly reduced during the follow-up (p<0.05). No significant difference was found in the mean BCVA, the visual field and the ERG parameters during the treatment compared with the baseline (p>0.05). In 20 out of 21 patients (95%) who received systemic corticosteroids, the corticosteroids could be tapered to a daily dose of ≤10 mg (rate 0.26/patient-year). Drug-related side effects occurred in 12 patients (50%, rate 0.16/patient-year). In four patients (17%), a therapy switch from MMF to MPS was undertaken due to gastrointestinal discomfort.

Conclusions Derivatives of mycophenolic acid are effective and safe drugs for the treatment of BSCR. In cases with gastrointestinal side effects, a therapy switch from MMF to MPS should be considered.

  • Inflammation

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