FAST Uveitis Trial: Mycophenolate Mofetil Is Not Superior to Methotrexate

The use of mycophenolate mofetil is not superior to methotrexate in controlling inflammation among individuals with noninfectious uveitis, according to results of the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial.¹

“This study gives doctors and their patients with uveitis a starting point when considering treatment beyond corticosteroids,” the study’s lead author, Nisha Acharya, MD, MS, from the University of California, San Francisco, said in a press release issued by the National Institutes of Health’s National Eye Institute.²

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In the study, the researchers randomly assigned 216 participants to receive treatment with either oral methotrexate, 25 mg, weekly (n=107) or oral mycophenolate mofetil, 3 g, daily (n=109). The participants also tapered to a maximum dose of prednisone, 7.5 mg, daily.

In all, 194 participants completed follow-up through 6 months. Of these participants, 64 in the methotrexate group (66.7%) and 56 in the mycophenolate group (57.1%) experienced controlled inflammation in both eyes.

Among the participants with posterior uveitis or panuveitis, 58 in the methotrexate group (74.4%) and 42 in the mycophenolate group (55.3%) experienced controlled inflammation in both eyes.

Among the participants with intermediate uveitis, 6 in the methotrexate group (33.3%) and 14 in the mycophenolate group (63.6%) experienced controlled inflammation in both eyes.

“Based on this head-to-head clinical trial, methotrexate is as good as or better than mycophenolate for treating uveitis,” Dr Acharya said. “That’s important because the prior literature and a survey on treatment preferences suggests most clinicians believe the opposite. Now we have a randomized trial to provide guidance on treatment. Additionally, there’s a cost difference in the [United States] where mycophenolate to control uveitis is over 5 times more expensive.”²

—Colleen Murphy

References:

1. Rathinam SR, Gonzales JA, Thundikandy R, et al. Effect of corticosteroid-sparing treatment with mycophenolate mofetil vs methotrexate on inflammation in patients with uveitis: a randomized clinical trial. JAMA. 2019;322(10):936-945. doi:10.1001/jama.2019.12618.

2. Two commonly used uveitis drugs perform similarly in NIH-funded clinical trial [press release]. Bethesda, MD: National Institutes of Health’s National Eye Institute; September 10, 2019. https://nei.nih.gov/content/two-commonly-used-uveitis-drugs-perform-similarly-nih-funded-clinical-trial. Accessed September 10, 2019.