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Mycophenolate mofetil for ocular inflammation Daniel E; Thorne JE; Newcomb CW; Pujari SS; Kacmaz RO; Levy-Clarke GA; Nussenblatt RB; Rosenbaum JT; Suhler EB; Foster CS; Jabs DA; Kempen JHAm J Ophthalmol 2010[Mar]; 149 (3): 423-32.e1-2PURPOSE: To evaluate mycophenolate mofetil as a single noncorticosteroid immunosuppressive treatment for noninfectious ocular inflammatory diseases. DESIGN: Retrospective cohort study. METHODS: Characteristics of patients with noninfectious ocular inflammation treated with mycophenolate mofetil at 4 subspecialty clinics from 1995 to 2007 were abstracted by expert reviewers in a standardized chart review of every eye at every visit. Main outcomes measured were control of inflammation, corticosteroid-sparing effects, and discontinuation of mycophenolate mofetil (including the reasons for discontinuation). Survival analysis was used to estimate the incidence of outcomes, and to identify risk factors for each. RESULTS: Among 236 patients (397 eyes) treated with mycophenolate mofetil monotherapy, 20.3%, 11.9%, and 39.8% had anterior uveitis, intermediate uveitis, and posterior uveitis or panuveitis respectively; 14% had scleritis; 7.6% had mucous membrane pemphigoid; and 6.4% had other ocular inflammatory diseases. By Kaplan-Meier estimation, complete control of inflammation--sustained over consecutive visits spanning at least 28 days--was achieved in 53% and 73% of patients within 6 months and 1 year respectively. Systemic corticosteroid dosage was reduced to 10 mg of prednisone or less, while maintaining sustained control of inflammation, in 41% and 55% of patients in 6 months and 1 year respectively. Twelve percent of patients discontinued mycophenolate mofetil within the first year because of side effects of therapy. CONCLUSIONS: Given sufficient time, mycophenolate mofetil was effective in managing ocular inflammation in approximately half of the treated patients. Treatment-limiting side effects were observed in 12% of patients and typically were reversible.|Adolescent[MESH]|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Anti-Inflammatory Agents, Non-Steroidal/adverse effects/*therapeutic use[MESH]|Child[MESH]|Female[MESH]|Follow-Up Studies[MESH]|Humans[MESH]|Immunosuppressive Agents/adverse effects/*therapeutic use[MESH]|Male[MESH]|Middle Aged[MESH]|Mycophenolic Acid/adverse effects/*analogs & derivatives/therapeutic use[MESH]|Pemphigoid, Benign Mucous Membrane/*drug therapy/physiopathology[MESH]|Prednisone/administration & dosage[MESH]|Retrospective Studies[MESH]|Risk Factors[MESH]|Scleritis/*drug therapy/physiopathology[MESH]|Treatment Outcome[MESH]|Uveitis/*drug therapy/physiopathology[MESH]|Visual Acuity/physiology[MESH] |
