Advances in the Treatment of Intermediate and Posterior Uveitis

Samantha Fraser-Bell; Carlos Pavesio

Disclosures

Expert Rev Ophthalmol. 2008;3(4):449-456. 

In This Article

Mycophenolate Mofetil

Similar to azathioprine, MMF inhibits purine synthesis. It is more specific than azathioprine as selectively inhibits inosine monophosphate dehydrogenase, an enzyme required for the de novo synthesis of purines. As T and B cells rely solely on this pathway for production of guanosine nucleotides for their DNA synthesis, the proliferation of these cells is inhibited,[14] whereas other cells are capable of using the salvage pathway. Thereby it inhibits the proliferation of lymphocytes, the synthesis of antibodies, and also interferes with cellular adhesion to the vascular walls and reduces the migration of leucocytes to areas of inflammation. Mycophenolate is derived from the fungus Penicillin stoloniferum. It is metabolized in the liver to its active form, mycophenolic acid.

There is more than 10 years of experience in the use of MMF in organ transplantation, especially renal transplantation. The drug has also been used with good effect in the treatment of bullous pemphigoid,[15] pemphigus vulgaris,[16] ocular pemphigoid, rheumatoid arthritis,[17] autoimmune hemolytic anemia, systemic lupus erythematosus[18] and Crohn's disease.[19] Efficacy has been more recently demonstrated in inflammatory eye diseases including scleritis and anterior, intermediate and posterior uveitis.[20,21,22,23,24]

The recommended dose is 2-3 g per day in divided doses. The medication is generally well-tolerated with the most common side effects being gastrointestinal (nausea and diarrhea) in approximately a third and mild leucopenia. With the higher doses used in transplant patients, lymphoma, skin cancers and opportunistic infections - especially cytomegalovirus and Herpes simplex infections - have been reported.

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