Mycophenolic acid in the treatment of birdshot chorioretinopathy: long-term follow-up

Br J Ophthalmol. 2015 Jan;99(1):87-91. doi: 10.1136/bjophthalmol-2014-305535. Epub 2014 Jul 24.

Abstract

Aim: To assess the long-term efficacy and tolerability of both derivatives of mycophenolic acid, mycophenolate mofetil (MMF) and mycophenolate sodium (MPS), in the therapy of patients with birdshot chorioretinopathy (BSCR).

Methods: Retrospective analysis of 24 patients (48 eyes) with BSCR, treated with MMF or MPS with a follow-up of at least 1 year. The main outcome measures included control of inflammation, steroid-sparing potential and side effects. Secondary outcome measure was the development of retinal function during the therapy measured by best-corrected visual acuity (BCVA), visual field and/or electroretinography (ERG).

Results: Twelve patients (50%) were treated with MMF and 12 patients (50%) with MPS. Control of intraocular inflammation, defined as complete lack of clinical and angiographic signs of inflammatory activity, was achieved in 16 of 24 patients (67%). The angiographic signs of activity were significantly reduced during the follow-up (p<0.05). No significant difference was found in the mean BCVA, the visual field and the ERG parameters during the treatment compared with the baseline (p>0.05). In 20 out of 21 patients (95%) who received systemic corticosteroids, the corticosteroids could be tapered to a daily dose of ≤10 mg (rate 0.26/patient-year). Drug-related side effects occurred in 12 patients (50%, rate 0.16/patient-year). In four patients (17%), a therapy switch from MMF to MPS was undertaken due to gastrointestinal discomfort.

Conclusions: Derivatives of mycophenolic acid are effective and safe drugs for the treatment of BSCR. In cases with gastrointestinal side effects, a therapy switch from MMF to MPS should be considered.

Keywords: Inflammation.

MeSH terms

  • Adult
  • Aged
  • Birdshot Chorioretinopathy
  • Chorioretinitis / diagnosis
  • Chorioretinitis / drug therapy*
  • Chorioretinitis / physiopathology
  • Electroretinography
  • Female
  • Fluorescein Angiography
  • Follow-Up Studies
  • Glucocorticoids / therapeutic use
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use*
  • Male
  • Middle Aged
  • Mycophenolic Acid / adverse effects
  • Mycophenolic Acid / analogs & derivatives*
  • Mycophenolic Acid / therapeutic use
  • Retina / physiopathology
  • Retrospective Studies
  • Tomography, Optical Coherence
  • Visual Acuity / physiology
  • Visual Fields / physiology

Substances

  • Glucocorticoids
  • Immunosuppressive Agents
  • Mycophenolic Acid