Immunosuppressive treatment with Mycophenolate mofetil (CellCept) in the therapy of uveitis

Background. Severe forms of uveitis can often only be managed sufficiently with systemic immunosuppression. All available drugs are known for their re lative high rate of side-effects. Mycophenolate mofetil (MMF), an immunosup pressant successfully used in management after organ transplantation and ma ny autoimmune diseases, has shown remarkably less side-effects when used fo r various forms of uveitis in monotherapy or in combination with corticoste roids. The aim of this multicenter-study was to investigate if monotherapy with MMF is effective in Various forms of uveitis. Method and patients. Ten patients with anterior uveitis (n=3), intermediate uveitis (n=2), panuveitis (n=4) and retinal vasculitis (n=1) were treated in a prospective study with 2x1 g MMF daily. Previous immunosuppression had been discontinued because of side-effects or ineffectivity in all patients . In these patients MMF was given in addition to the other immunosuppressan t at the beginning of treatment. Results. The follow-up time ranged from 1 to 12 months (mean 4.5 months). U nder therapy with MMF (monotherapy in 4 patients, additional prednisolone i n 5 patients and additional metotrexate in 1 patient)8 patients remained fr ee of recurrences. In one female patient depression of inflammation activit y was only achieved after cessation of therapy with Cyclosporin A in combin ation with MMF and a switch to methotrexate. Another patient with a bilater al uveitis was free of recurrences in only one eye,the second eye did not d evelop recurrence due to the additional corticosteroid treatment. Side-effe cts were diarrhoea in one patient and probably gastrointestinal problems in another (leading to cessation of therapy in both patients) and in another case nausea,vomitus and alopecia 10 months after beginning therapy Conclusions. MMF as a new immunosuppressant stopped inflammation or drastic ally reduced the rate of recurrences in 8 oat of 10 patients with uveitis w hich was previously not brought under control by other immunosuppressants. The side-effects were tolerable in comparison with other immunosuppressive agents. More patients, longer follow-up times and a comparative study with Cyclosporin A are required to assess the long-term therapeutical success.