, Volume 98, Issue 7, pp 647-651

Immunsuppressive Therapie mit Mycophenolat Mofetil (CellCept®) in der Behandlung der Uveitis

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Zusammenfassung

Fragestellung. Ziel der vorliegenden multizentrischen Studie war, die Wirksamkeit von Mycophenolat Mofetil (MMF) als Monotherapeutikum bei verschiedenen Formen der Uveitis zu untersuchen.

Patienten und Methode. Zehn Patienten mit anteriorer Uveitis (n=3), intermediärer Uveitis (n=2), Panuveitis (n=4) und retinaler Vaskulitis (n=1) wurden in einer prospektiven Studie mit 2×1 g MMF/Tag therapiert.

Ergebnisse. Der Behandlungszeitraum betrug 1–12 Monate. Bei 8 Patienten zeigte sich unter der MMF-Therapie kein weiteres Rezidiv. Zwei Patientinnen wurden erst durch Umstellung auf Methotrexat bzw. durch eine begleitende Steroidmedikation rezidivfrei. An Nebenwirkungen klagte ein Patient über Diarrhö, die zum Absetzen der Therapie führte. Bei einer Patientin kam es 10 Monate nach Therapiebeginn zu Übelkeit, Erbrechen und Haarausfall.

Schlussfolgerung. Die Immunsuppression mit MMF hat bei 8 von 10 Uveitispatienten zu einer Beruhigung der Entzündungsaktivität geführt. Die Nebenwirkungen sind eher milde verglichen mit denen anderer Immunsuppressiva.

Abstract

Background. Severe forms of uveitis can often only be managed sufficiently with systemic immunosuppression. All available drugs are known for their relative high rate of side-effects. Mycophenolate mofetil (MMF), an immunosuppressant successfully used in management after organ transplantation and many autoimmune diseases, has shown remarkably less side-effects when used for various forms of uveitis in monotherapy or in combination with corticosteroids. 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 2×1 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 immunosuppressant at the beginning of treatment.

Results. The follow-up time ranged from 1 to 12 months (mean 4.5 months). Under therapy with MMF (monotherapy in 4 patients, additional prednisolone in 5 patients and additional metotrexate in 1 patient) 8 patients remained free of recurrences. In one female patient depression of inflammation activity was only achieved after cessation of therapy with Cyclosporin A in combination with MMF and a switch to methotrexate. Another patient with a bilateral uveitis was free of recurrences in only one eye, the second eye did not develop recurrence due to the additional corticosteroid treatment. Side-effects 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 drastically reduced the rate of recurrences in 8 out of 10 patients with uveitis which 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.