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MUST study shows treatment benefits of fluocinolone implant for uveitis at 2 years
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FORT LAUDERDALE, Fla. — Patients with an active fluocinolone acetonide implant to treat noninfectious intermediate, posterior or panuveitis experienced similar visual acuity outcomes as patients who received systemic corticosteroids plus immunosuppression when indicated, a speaker said here.
“While the implant remains active, it is similar to systemic treatment in visual acuity outcomes,” Thomas A. Albini, MD, said at the Retina World Congress.
The MUST study evaluated the outcomes of approximately 400 patients with noninfectious intermediate, posterior or panuveitis treated with an intravitreous fluocinolone acetonide implant or systemic anti-inflammatory therapy. The primary outcome of the study was visual acuity at 24 months, with inflammation as a secondary outcome.
At 2 years, there was no difference in visual acuity between the two groups, but for secondary measures of inflammatory control, the implant outperformed the systemic therapy group at every timepoint, Albini said.
The study went on through 7 years, and the systemic therapy group was associated with better visual acuity outcomes compared with the implant group. However, the implant only lasts 3 years, Albini said, and not all patients received another one.
The primary outcome of the study, the first 2 years of treatment, showed the implant did well in terms of visual acuity and better in terms of inflammatory control than systemic therapy. But the secondary outcome, the next 5 years, is “kind of a post hoc analysis” and was data gathered after the fact and not in a preplanned fashion. This is now what is being cited as the final take-home message, Albini said.
“After the third year of the study, the vast majority of patients in the implant arm don’t have an implant. How can you conclude anything about the function of this implant if most of the patients in the implant arm don’t have an implant?” he said.
While the implant remains active, visual acuity outcomes are similar to systemic therapy and it outperforms systemic therapy in secondary outcomes. It does result in a higher number of cataract and glaucoma procedures, Albini noted. – by Robert Linnehan
Reference:
Albini TA. MUST study outcomes and impact on clinical practice. Presented at: Retina World Congress; March 21 to 24, 2019; Fort Lauderdale, Fla.
Disclosure: Albini reports he is a consultant and advisor for AbbVie, Bausch + Lomb, Clearside, Genentech, Allergan, pSivida, Santen Inc. and Mallinckrodt.