Real-World Efficacy and Safety of Mycophenolate Mofetil in Active Moderate-to-Sight-Threatening Thyroid Eye Disease

Nicole Quah Qin Xian,1 Ahmed Alnahrawy,2 Rashmi Akshikar,2 Vickie Lee2,3 1Department of Stroke Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; 2Department of Ophthalmology, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK; 3Department of Su...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Quah Qin Xian N, Alnahrawy A, Akshikar R, Lee V
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	graves orbitopathy dysthyroid optic neuropathy cellcept Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/028d212c3bfa4d0dbc4c9c8354d162ff
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:028d212c3bfa4d0dbc4c9c8354d162ff
record_format	dspace
spelling	oai:doaj.org-article:028d212c3bfa4d0dbc4c9c8354d162ff2021-12-02T16:58:09ZReal-World Efficacy and Safety of Mycophenolate Mofetil in Active Moderate-to-Sight-Threatening Thyroid Eye Disease1177-5483https://doaj.org/article/028d212c3bfa4d0dbc4c9c8354d162ff2021-05-01T00:00:00Zhttps://www.dovepress.com/real-world-efficacy-and-safety-of-mycophenolate-mofetil-in-active-mode-peer-reviewed-fulltext-article-OPTHhttps://doaj.org/toc/1177-5483Nicole Quah Qin Xian,1 Ahmed Alnahrawy,2 Rashmi Akshikar,2 Vickie Lee2,3 1Department of Stroke Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; 2Department of Ophthalmology, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK; 3Department of Surgery & Cancer, General Surgery, Faculty of Medicine,Imperial College London, London, UKCorrespondence: Vickie LeeDepartment of Ophthalmology, Western Eye Hospital, Imperial College Healthcare NHS Trust, 153– 173 Marylebone Road, Marylebone, London, NW1 5QH, UKTel +44 20 3312 6666Email vickie.lee@nhs.netPurpose: There is no universal consensus on second-line agents for the treatment of moderate/severe to sight-threatening thyroid eye disease (TED) to maintain remission after first-line intravenous methylprednisolone (IVMP). This study investigates the efficacy and safety of mycophenolate mofetil (MMF) in TED patients in a real-world setting and over a longer period than previous randomized controlled trials.Methods: A retrospective cohort study of TED patients with active moderate/severe to sight-threatening TED seen over a 4-year period. Data collected were visual acuity (VA), Clinical Activity Score (CAS), Gorman Diplopia scores, MMF dosing and side effects at 24, 52 and 78 weeks. Clinical efficacy was defined as an absence of relapse: no decline in best corrected LogMAR VA, no need for further steroids, no increase in CAS of ≥ 2.Results: Out of 23 patients, 20 patients were included in this study. 10% (2/20) stopped MMF before 24 weeks. Median duration of MMF treatment was 76 weeks (1– 140 weeks). 55% (11/20) had dysthyroid optic neuropathy (DON). In those with active moderate-severe TED without DON, clinical efficacy was seen in 100% (8/8) at 24 weeks, 87.5% (7/8) at 52 weeks, and 83.3% (5/6) at 78 weeks, with CAS decreasing from a baseline of 2.78± 1.99 to 0.50± 0.58 at 24 weeks, 0.50± 0.82 at 52 weeks and 1.00± 1.30 at 78 weeks. In DON, improvements were seen in 90% (9/10) at 24 weeks, 100% (7/7) at 52 weeks and 100% (4/4) at 78 weeks, with significantly reduced CAS scores from 2.55± 1.54 to 0.83± 1.27, 1.00± 1.17 and 0.63± 0.95 at 24, 52 and 78 weeks, respectively. Gorman score, VA and soft tissue inflammation parameters also improved throughout. There were two significant side effects over the treatment period.Conclusion: MMF appears to be an effective and safe second-line immunosuppressive agent. Further studies aimed at elucidating optimal dosing regimens and ideal treatment duration will prove helpful.Keywords: Graves orbitopathy, dysthyroid optic neuropathy, CellCeptQuah Qin Xian NAlnahrawy AAkshikar RLee VDove Medical Pressarticlegraves orbitopathydysthyroid optic neuropathycellceptOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 15, Pp 1921-1932 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	graves orbitopathy dysthyroid optic neuropathy cellcept Ophthalmology RE1-994
spellingShingle	graves orbitopathy dysthyroid optic neuropathy cellcept Ophthalmology RE1-994 Quah Qin Xian N Alnahrawy A Akshikar R Lee V Real-World Efficacy and Safety of Mycophenolate Mofetil in Active Moderate-to-Sight-Threatening Thyroid Eye Disease
description	Nicole Quah Qin Xian,1 Ahmed Alnahrawy,2 Rashmi Akshikar,2 Vickie Lee2,3 1Department of Stroke Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; 2Department of Ophthalmology, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK; 3Department of Surgery & Cancer, General Surgery, Faculty of Medicine,Imperial College London, London, UKCorrespondence: Vickie LeeDepartment of Ophthalmology, Western Eye Hospital, Imperial College Healthcare NHS Trust, 153– 173 Marylebone Road, Marylebone, London, NW1 5QH, UKTel +44 20 3312 6666Email vickie.lee@nhs.netPurpose: There is no universal consensus on second-line agents for the treatment of moderate/severe to sight-threatening thyroid eye disease (TED) to maintain remission after first-line intravenous methylprednisolone (IVMP). This study investigates the efficacy and safety of mycophenolate mofetil (MMF) in TED patients in a real-world setting and over a longer period than previous randomized controlled trials.Methods: A retrospective cohort study of TED patients with active moderate/severe to sight-threatening TED seen over a 4-year period. Data collected were visual acuity (VA), Clinical Activity Score (CAS), Gorman Diplopia scores, MMF dosing and side effects at 24, 52 and 78 weeks. Clinical efficacy was defined as an absence of relapse: no decline in best corrected LogMAR VA, no need for further steroids, no increase in CAS of ≥ 2.Results: Out of 23 patients, 20 patients were included in this study. 10% (2/20) stopped MMF before 24 weeks. Median duration of MMF treatment was 76 weeks (1– 140 weeks). 55% (11/20) had dysthyroid optic neuropathy (DON). In those with active moderate-severe TED without DON, clinical efficacy was seen in 100% (8/8) at 24 weeks, 87.5% (7/8) at 52 weeks, and 83.3% (5/6) at 78 weeks, with CAS decreasing from a baseline of 2.78± 1.99 to 0.50± 0.58 at 24 weeks, 0.50± 0.82 at 52 weeks and 1.00± 1.30 at 78 weeks. In DON, improvements were seen in 90% (9/10) at 24 weeks, 100% (7/7) at 52 weeks and 100% (4/4) at 78 weeks, with significantly reduced CAS scores from 2.55± 1.54 to 0.83± 1.27, 1.00± 1.17 and 0.63± 0.95 at 24, 52 and 78 weeks, respectively. Gorman score, VA and soft tissue inflammation parameters also improved throughout. There were two significant side effects over the treatment period.Conclusion: MMF appears to be an effective and safe second-line immunosuppressive agent. Further studies aimed at elucidating optimal dosing regimens and ideal treatment duration will prove helpful.Keywords: Graves orbitopathy, dysthyroid optic neuropathy, CellCept
format	article
author	Quah Qin Xian N Alnahrawy A Akshikar R Lee V
author_facet	Quah Qin Xian N Alnahrawy A Akshikar R Lee V
author_sort	Quah Qin Xian N
title	Real-World Efficacy and Safety of Mycophenolate Mofetil in Active Moderate-to-Sight-Threatening Thyroid Eye Disease
title_short	Real-World Efficacy and Safety of Mycophenolate Mofetil in Active Moderate-to-Sight-Threatening Thyroid Eye Disease
title_full	Real-World Efficacy and Safety of Mycophenolate Mofetil in Active Moderate-to-Sight-Threatening Thyroid Eye Disease
title_fullStr	Real-World Efficacy and Safety of Mycophenolate Mofetil in Active Moderate-to-Sight-Threatening Thyroid Eye Disease
title_full_unstemmed	Real-World Efficacy and Safety of Mycophenolate Mofetil in Active Moderate-to-Sight-Threatening Thyroid Eye Disease
title_sort	real-world efficacy and safety of mycophenolate mofetil in active moderate-to-sight-threatening thyroid eye disease
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/028d212c3bfa4d0dbc4c9c8354d162ff
work_keys_str_mv	AT quahqinxiann realworldefficacyandsafetyofmycophenolatemofetilinactivemoderatetosightthreateningthyroideyedisease AT alnahrawya realworldefficacyandsafetyofmycophenolatemofetilinactivemoderatetosightthreateningthyroideyedisease AT akshikarr realworldefficacyandsafetyofmycophenolatemofetilinactivemoderatetosightthreateningthyroideyedisease AT leev realworldefficacyandsafetyofmycophenolatemofetilinactivemoderatetosightthreateningthyroideyedisease
_version_	1718382367585861632

Real-World Efficacy and Safety of Mycophenolate Mofetil in Active Moderate-to-Sight-Threatening Thyroid Eye Disease

Ejemplares similares