Mycophenolate mofetil: A useful immunosuppressive in inflammatory eye disease☆
Section snippets
Patients and methods
All patients with uveitis treated with MMF at Moorfields Eye Hospital were assessed for treatment outcome and adverse effects while receiving the drug. Mycophenolate mofetil was used as a third agent in patients who responded inadequately to steroids used concomitantly with cyclosporine (CsA) or was substituted for azathioprine as a second- or third-line drug. Mycophenolate mofetil was used also as a steroid-sparing agent in patients whose steroid dose could not be reduced to an acceptable
Results
In total, 11 patients received MMF. Table 1, Table 2 outline their demographics, diagnoses, treatment regimens before and after starting MMF, and duration of treatment with MMF. The types of inflammation were divided into two categories on the basis of the part of the eye affected: (I) panuveitis (Table 1) and (II) scleritis (Table 2). There were seven patients in group I. Five of these patients (patients, 2, 3, 4, 6, and 7) did exceptionally well without significant side effects. In all five,
Discussion
Mycophenolate mofetil, formerly known as RS-61443, is a fermentation product of several Penicillium species and the ester product of MPA.14 After oral administration, MMF is absorbed within 30 minutes and broken down in the liver to MPA, its metabolically active form.6 Mycophenolate mofetil is not generally detectable in plasma, and its bioavailability is approximately 94% with respect to MPA.6 Antacids given simultaneously may interfere with the absorption of MMF, and it is therefore suggested
References (21)
Oral toleranceimmune mechanisms and treatment of autoimmune diseases
Immunol Today
(1997)- et al.
Mycophenolic acid for psoriasis. A review of pharmacology, long-term efficacy, and safety
J Am Acad Dermatol
(1987) - et al.
Bullous pemphigoid treated with mycophenolate mofetil
Lancet
(1997) - et al.
Treatment of pemphigus vulgaris with mycophenolate mofetil
Lancet
(1997) - et al.
Mycophenolate mofetil for severe autoimmune haemolytic anemia
Lancet
(1997) - et al.
Inhibition of experimental autoimmune uveoretinitis by mycophenolate mofetil, an inhibitor of purine metabolism
Exp Eye Res
(1995) Mycophenolate mofetil
Lancet
(1996)- et al.
Causes and frequency of blindness in patients with intraocular inflammatory disease
Br J Ophthalmol
(1996) New therapeutic options in uveitis
Eye
(1997)Experimental approaches to specific immunotherapies in autoimmune diseasefuture treatment of endogenous posterior uveitis?
Br J Ophthalmol
(1995)
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2020, American Journal of Ophthalmology Case ReportsCitation Excerpt :Additionally, given the multi-organ involvement, recurrence of skin manifestations, and need to provide long-term control of the underlying immunologic process, the patient was started on mycophenolate mofetil, which has previously shown efficacy in ulcerative LCV recalcitrant to colchicine and dapsone.51,52 Mycophenolate mofetil has potent anti-inflammatory effects, high medication compliance, and few severe adverse effects in long-term use.53,54 The medical care for the index patient consisted of a multi-disciplinary team, including an ophthalmologist, a rheumatologist, and a dermatologist.
Uveitis and glaucoma: new insights in the pathogenesis and treatment
2015, Progress in Brain ResearchCitation Excerpt :Immunomodulatory therapy should be considered in severe uveitis to replace or reduce the dose of corticosteroids required. These include T-cell inhibitors, alkylating agents, antimetabolites, and more recently, biologic response modifiers, such as tumor necrosis factor-α inhibitors and antilymphocyte agents (Androudi et al., 2003; Bom et al., 2001; Dick et al., 1997; Foeldvari et al., 2007; Larkin and Lightman, 1999; Okada, 2005; Saurenmann et al., 2006). Adequate control of intraocular inflammation reduces posterior synechiae and PAS formation (Panek et al., 1990).
Determination of Mycophenolic acid in the vitreous humor using the HPLC-ESI-MS/MS method: Application of intraocular pharmacokinetics study in rabbit eyes with ophthalmic implantable device
2013, Journal of Pharmaceutical and Biomedical AnalysisCitation Excerpt :Both people and animals with intraocular diseases, such as uveitis and sclerites, have also been undergoing experimental oral treatment with MPA. These experiments have been presenting positive results and have been producing a better quality of life for patients when compared to treatment with corticosteroids and other immunosuppressive agents [3–12]. It is well known that intraocular bioavailability of drugs, when administered by classical routes (topical, intravenous, and oral), is extremely low because of natural barriers of the eye that block drug penetration.
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