Methotrexate as good as mycophenolate mofetil for uveitis

In the treatment of patients with uveitis, methotrexate is just as effective as mycophenolate mofetil, with both producing significant improvements in vision- and health-related quality of life (QoL) over 1 year of follow-up, as shown in a study.

The analysis used data from a cohort of 216 patients with noninfectious uveitis from India, the United States, Australia, Saudi Arabia, and Mexico. They had been randomized to receive either 25-mg weekly oral methotrexate or 1.5-g twice daily oral mycophenolate mofetil.

Median changes in QoL were assessed using Wilcoxon signed rank tests, and differences between treatment groups were calculated using linear mixed models, which were controlled for baseline QoL score, age, sex, and site. Among Indian patients, vision-related QoL scores from a general scale (NEI-VFQ) and a culturally specific scale (IND-VFQ) were compared using Pearson correlation tests.

A total of 193 patients responded to treatment. Vision-related QoL increased from baseline by a median of 12.0 points (interquartile range [IQR], 1.0–26.1; NEI-VFQ scale), physical health-related QoL rose by a median of 3.6 points (IQR, –1.4 to 14.9; PCS SF-36v2), and mental health-related QoL improved by a median of 3.0 points (IQR, –3.7 to 11.9; MCS SF-36v2).

The improvements in NEI-VFQ, SF-36v2 PCS, and SF-36v2 MCS scores were all significant (p<0.01).

In linear mixed models, QoL did not differ between the treatment arms for each QoL assessment (NEI-VFQ, IND-VFQ, PCS SF-36v2, and MCS SF-36v2; p>0.05 for all).

Finally, NEI-VFQ and IND-VFQ scores for Indian participants showed a strong correlation at baseline and with the efficacy outcomes.

The present data highlight the potential of antimetabolites for improving overall patient well-being and daily functioning.