For a study, researchers sought to assess the outcomes of uveitic macular edema in patients treated with methotrexate or mycophenolate mofetil at 6 and 12 months. Between August 2013 and August 2017, patients were enrolled in the First-line Antimetabolites as Steroid-sparing Treatment (FAST) Uveitis Trial. For 12 months, patients were randomly assigned to either oral methotrexate 25 mg weekly or mycophenolate mofetil 1.5 g twice daily, coupled with a corticosteroid taper. At each visit, all patients underwent spectral-domain OCT imaging in addition to a standardized clinical evaluation. Patients who achieved treatment success continued to receive the same treatment for another six months beyond the primary endpoint, whereas treatment failures transferred to the other treatment group.
Uveitic macular edema affected 42 eyes (30 patients) in the methotrexate group and 55 eyes (41 patients) in the mycophenolate group in the FAST Trial. In the methotrexate and mycophenolate groups, the baseline median central subfield thickness was 359 m and 342 m, respectively. However, macular thickness reduced from baseline by 30.5 m (interquartile range [IQR], 132.3 to 4.0) and 54 m (IQR, 95.5 to 4.5) in the methotrexate and mycophenolate groups, respectively (P=0.73), for those who continued on the same medication. Macular thickness fell by 12.5 m (IQR, 32.3 to 0.5) and 50 m (IQR, 181.0 to 10.0) in the methotrexate and mycophenolate groups, respectively, after switching treatments at 6 months (P=0.34). At 12 months, 7 of 19 eyes on methotrexate (37%) had resolved macular edema compared to 15 of 25 eyes on mycophenolate (60%) (P=0.10). In addition, 8 of 17 eyes (47%) on methotrexate and 6 of 11 eyes (55%) on mycophenolate showed remission of macular edema (P=0.92). Treating uveitic macular edema with methotrexate or mycophenolate mofetil leads to equal improvements in macular thickness at 6 and 12 months. Approximately half of the eyes in each antimetabolite group exhibited chronic macular edema after 12 months.