The role of mycophenolate mofetil in uveitis therapy

Purpose To summarize current evidences for mycophenolate mofetil (MMF) therapies in the treatment of uveitis. The review emphasizes the safety and efficacy of MMF in the treatment of inflammatory ocular diseases.Methods The review describes published research since early nineties, and reports the experience of a tertiary-referral center.Results Studies in other disciplines have proven the efficacy of MMF with a long-lasting remission in patients affected by Crohn’s disease, severe atopic dermatitis, Wegener’s granulomatosis, rheumatoid arthritis, pemphigus vugaris, and psoriasis. Recent publications have confirmed the satisfactory control of uveitis with MMF in a large cohort of patients. Severe ocular inflammations can also have late sequela, generated by the chronic damage to the retina: cystoid macular oedema (CMO) and choroidal neovascularization (CNV) can be late occurrences. MMF has been recently used for the control of such sequela, showing a promising role in the control of both CNV and CMO.Conclusion Non-infectious uveitis is one of the leading causes of visual impairment in ophthalmology. Steroids can control such disease and its sequela, but a long-term therapy with steroids could lead to complications such as high blood sugar level, osteoporosis, blood cell abnormalities, cataract and glaucoma. MMF is a reversible, non competitive, selective inhibitor of the de-novo pathway of purine synthesis; mycophenolic acid has a strong effect to Type II isoform of inosine monophosphate dehydrogenase enzyme, providing a stronger cytostatic effect on lymphocytes than on other cells types, with minor action to Type I expressed in most other cells. The specific action of MMF on selected targets makes it a promising drug for the control of non-infectious intraocular inflammations.