Systemic therapy tops implants in long-term treatment of uveitis

A 7-year extended follow-up of the MUST trial found that systemic corticosteroid and immunosuppressive therapy led to better visual acuity outcomes and fewer complications than intravitreous fluocinolone acetonide implants in eyes with uveitis.

The Multicenter Uveitis Steroid Treatment (MUST) trial compared the outcomes of these two strategies over a period of 2 years. Primary outcomes showed equal improvement of visual acuity, with an early statistically significant advantage of the implant at 6 months in patients with severe noninfectious intermediate, posterior or pan-uveitis.

In the extension period, 7-year data were available for 171 eyes in the implant group and 167 eyes in the systemic therapy group. No significant changes occurred up to 5 years, when the average visual acuity began to decline in the implant group. By year 7, vision had declined in this group by 6 letters, while the systemic therapy group gained 1.2 letters. The proportion of patients with legal blindness (20/200 or worse) was increased by 8% from baseline in the implant group and decreased by 1% in the systemic therapy group.

Active inflammation was initially more effectively reduced in the eyes receiving implant therapy, but at the same 5-year time point reactivations of uveitis began to occur more frequently, resulting in more eyes with active inflammation and increased rates of macular edema. Higher incidence of elevated IOP was seen in this group throughout the follow-up. By 7 years, 45% of eyes had undergone IOP lowering surgery compared with 12% of eyes in the systemic therapy group. In addition, 90% of phakic eyes in the implant group had undergone cataract surgery at 7 years compared with 50% in the systemic therapy group.

“However, these findings are limited by a 30% loss to follow-up, with possible selection bias,” the authors said. – by Michela Cimberle

Disclosure: Kempen reports he has been a consultant for AbbVie, Alcon, Allergan, Can-Fite, Clearside, Lux Biosciences, Roche, Sanofi Pasteur, Santen, Vitae and Xoma, and has received grant support from EyeGate Pharma, Lions Club International Foundation, FDA, Research to Prevent Blindness and the National Eye Institute. Please see the study for a full list of authors’ relevant financial disclosures.

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Source:

Kempen JH, et al. JAMA Ophthalmol. 2017;doi:10.1001/jama.2017.5103.