Risk of failing both methotrexate and mycophenolate mofetil from the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial
Abstract Background The antimetabolites methotrexate (MTX) and mycophenolate mofetil (MMF) are commonly used as initial corticosteroid-sparing treatment for uveitis. There is little data examining risk factors for failing both MTX and MMF. The objective of this study is to determine risk factors for...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2023-06-01
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| Series: | Journal of Ophthalmic Inflammation and Infection |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12348-023-00350-5 |
| _version_ | 1797806579240665088 |
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| author | Amit K. Reddy D. Claire Miller Amol A. Sura SR Rathinam John A Gonzales Radhika Thundikandy Anuradha Kanakath Bala Murugan Rajesh Vedhanayaki Lyndell L. Lim Eric B. Suhler Thuy Doan Hassan A. Al-Dhibi Debra A. Goldstein Lourdes Arellanes-Garcia Nisha R Acharya |
| author_facet | Amit K. Reddy D. Claire Miller Amol A. Sura SR Rathinam John A Gonzales Radhika Thundikandy Anuradha Kanakath Bala Murugan Rajesh Vedhanayaki Lyndell L. Lim Eric B. Suhler Thuy Doan Hassan A. Al-Dhibi Debra A. Goldstein Lourdes Arellanes-Garcia Nisha R Acharya |
| author_sort | Amit K. Reddy |
| collection | DOAJ |
| description | Abstract Background The antimetabolites methotrexate (MTX) and mycophenolate mofetil (MMF) are commonly used as initial corticosteroid-sparing treatment for uveitis. There is little data examining risk factors for failing both MTX and MMF. The objective of this study is to determine risk factors for failing both MTX and MMF in patients with non-infectious uveitis. Main body This is a sub-analysis of the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial, which was an international, multicenter, block-randomized, observer-masked, comparative effectiveness trial comparing MTX and MMF as initial treatments for non-infectious uveitis. This study was undertaken at multiple referral centers in India, the United States, Australia, Saudi Arabia and Mexico between 2013 and 2017. A total of 137 patients who completed all 12 months of follow-up from the FAST trial, were included in this study. The primary outcome was failing both antimetabolites over the 12 months of the trial. Potential predictors included: age, sex, bilateral involvement, anatomic location of the uveitis, presence of cystoid macular edema (CME) and retinal vasculitis at baseline visit, uveitis duration, and country/study sites as risk factors for failing both MTX and MMF. The presence of retinal vasculitis posterior to the equator on fluorescein angiogram was associated with failing both MTX and MMF. Conclusion Retinal vasculitis may be a risk factor for failing multiple antimetabolites. Clinicians could consider more quickly advancing these patients to other medication classes, such as biologics. |
| first_indexed | 2024-03-13T06:09:24Z |
| format | Article |
| id | doaj.art-7814edc1bcb64eb78feba23bf6b302d1 |
| institution | Directory Open Access Journal |
| issn | 1869-5760 |
| language | English |
| last_indexed | 2024-03-13T06:09:24Z |
| publishDate | 2023-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Journal of Ophthalmic Inflammation and Infection |
| spelling | doaj.art-7814edc1bcb64eb78feba23bf6b302d12023-06-11T11:22:25ZengSpringerOpenJournal of Ophthalmic Inflammation and Infection1869-57602023-06-011311510.1186/s12348-023-00350-5Risk of failing both methotrexate and mycophenolate mofetil from the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trialAmit K. Reddy0D. Claire Miller1Amol A. Sura2SR Rathinam3John A Gonzales4Radhika Thundikandy5Anuradha Kanakath6Bala Murugan7Rajesh Vedhanayaki8Lyndell L. Lim9Eric B. Suhler10Thuy Doan11Hassan A. Al-Dhibi12Debra A. Goldstein13Lourdes Arellanes-Garcia14Nisha R Acharya15F.I. Proctor Foundation, University of CaliforniaF.I. Proctor Foundation, University of CaliforniaF.I. Proctor Foundation, University of CaliforniaAravind Eye Hospitals and Postgraduate Institute of OphthalmologyF.I. Proctor Foundation, University of CaliforniaAravind Eye Hospitals and Postgraduate Institute of OphthalmologyAravind Eye Hospitals and Postgraduate Institute of OphthalmologyAravind Eye Hospitals and Postgraduate Institute of OphthalmologyAravind Eye Hospitals and Postgraduate Institute of OphthalmologyCentre for Eye Research Australia, Royal Victorian Eye and Ear HospitalCasey Eye Institute, Oregon Health and Science UniversityF.I. Proctor Foundation, University of CaliforniaDivision of Vitreoretinal Surgery and Uveitis, King Khaled Eye Specialist HospitalDepartment of Ophthalmology, Northwestern University Feinberg School of MedicineAsociación Para Evitar la CegueraF.I. Proctor Foundation, University of CaliforniaAbstract Background The antimetabolites methotrexate (MTX) and mycophenolate mofetil (MMF) are commonly used as initial corticosteroid-sparing treatment for uveitis. There is little data examining risk factors for failing both MTX and MMF. The objective of this study is to determine risk factors for failing both MTX and MMF in patients with non-infectious uveitis. Main body This is a sub-analysis of the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial, which was an international, multicenter, block-randomized, observer-masked, comparative effectiveness trial comparing MTX and MMF as initial treatments for non-infectious uveitis. This study was undertaken at multiple referral centers in India, the United States, Australia, Saudi Arabia and Mexico between 2013 and 2017. A total of 137 patients who completed all 12 months of follow-up from the FAST trial, were included in this study. The primary outcome was failing both antimetabolites over the 12 months of the trial. Potential predictors included: age, sex, bilateral involvement, anatomic location of the uveitis, presence of cystoid macular edema (CME) and retinal vasculitis at baseline visit, uveitis duration, and country/study sites as risk factors for failing both MTX and MMF. The presence of retinal vasculitis posterior to the equator on fluorescein angiogram was associated with failing both MTX and MMF. Conclusion Retinal vasculitis may be a risk factor for failing multiple antimetabolites. Clinicians could consider more quickly advancing these patients to other medication classes, such as biologics.https://doi.org/10.1186/s12348-023-00350-5Non-infectious uveitisImmunomodulatory therapyMethotrexateMycophenolate mofetilRetinal vasculitis |
| spellingShingle | Amit K. Reddy D. Claire Miller Amol A. Sura SR Rathinam John A Gonzales Radhika Thundikandy Anuradha Kanakath Bala Murugan Rajesh Vedhanayaki Lyndell L. Lim Eric B. Suhler Thuy Doan Hassan A. Al-Dhibi Debra A. Goldstein Lourdes Arellanes-Garcia Nisha R Acharya Risk of failing both methotrexate and mycophenolate mofetil from the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial Journal of Ophthalmic Inflammation and Infection Non-infectious uveitis Immunomodulatory therapy Methotrexate Mycophenolate mofetil Retinal vasculitis |
| title | Risk of failing both methotrexate and mycophenolate mofetil from the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial |
| title_full | Risk of failing both methotrexate and mycophenolate mofetil from the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial |
| title_fullStr | Risk of failing both methotrexate and mycophenolate mofetil from the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial |
| title_full_unstemmed | Risk of failing both methotrexate and mycophenolate mofetil from the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial |
| title_short | Risk of failing both methotrexate and mycophenolate mofetil from the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial |
| title_sort | risk of failing both methotrexate and mycophenolate mofetil from the first line antimetabolites as steroid sparing treatment fast uveitis trial |
| topic | Non-infectious uveitis Immunomodulatory therapy Methotrexate Mycophenolate mofetil Retinal vasculitis |
| url | https://doi.org/10.1186/s12348-023-00350-5 |
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