Mycophenolate versus Methotrexate in Non-infectious Ocular Inflammatory Disease: A Systematic Review and Meta-Analysis

ABSTRACT

Purpose

To compare the outcomes of mycophenolate mofetil (MMF) versus methotrexate (MTX) in non-infectious ocular inflammatory disease (NIOID).

Methods

The study was performed as per the PRISMA Guidelines. A search identified all studies comparing MMF versus MTX in NIOID. Treatment result and side effects were primary outcomes.

Results

Four studies enrolling 905 patients were identified. There was no significant difference between MMF and MTX groups in overall treatment success (OR = 0.97, P = .96), treatment failure (OR = 0.86, P = .85). MTX showed a significantly improved effect in cases involving posterior uveitis and panuveitis (OR = 0.41, P = .003). In addition, MTX was associated with a faster median time to treatment success and had less side effects when compared to MTX, however this was not significant. For secondary outcomes, no significant difference was found in visual acuity and resolution of macular oedema.

Conclusion

MMF is comparable to MTX in the treatment of NIOID.

KEYWORDS:

• Mycophenolate mofetil
• methotrexate
• non-infectious ocular inflammation
• uveitis
• scleritis

Highlights

• No significant difference between MMF and MTX in the overall treatment success and failure at 6 months in non-infectious ocular inflammation.

• MTX showed better success rate in posterior and panuveitis cases.

• MMF showed less side effects than MTX but failed to reach statistical significance.

• MMF and MTX are comparable in visual acuity improvement and resolution of macular oedema.

Availability of data and materials

The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.

Author contributions

Mohammad Karam and Abdulmalik Alsaif contributed equally to the paper as joint first authors in the study concept and design as well as data analysis and interpretation. Abdulrahman Al-Naseem and Amrit Hayre contributed to the data acquisition. Ahmad Aldubaikhi and Narvair Kahlar were responsible for quality and bias assessment of the included studies. All the aforementioned authors were responsible for drafting the manuscript. Abdurrahman Al Jabbouri and Salem Al-Mutairi contributed to the supervision of the study and critical review. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.