Methotrexate and Mycophenolate Mofetil for UVEITIS (FAST)
Uveitis
About this trial
This is an interventional treatment trial for Uveitis focused on measuring antimetabolite, noninfectious
Eligibility Criteria
Inclusion Criteria:
- All the following criteria must be met at enrollment:
Historical non-infectious intermediate, anterior and intermediate, posterior or panuveitis in at least one eye
Active inflammation within the last 180 days, defined by the presence of any of the following (in at least one eye) according to SUN criteria:
- ≥ 2+ anterior chamber cells
- ≥ 2+ vitreous haze
- active retinal or choroidal lesions
Active inflammation at enrollment, defined by the presence of any of the following (in at least one eye) according to SUN criteria:
- ≥1+ anterior chamber cells and/or
- ≥1+ vitreous haze and/or
- active retinal/choroidal lesions
At least one of the following criteria must be met before or at enrollment:
- Active inflammation after 4 weeks of high-dose (1mg/kg prednisone equivalent) corticosteroid treatment or 4 weeks following a regional corticosteroid injection
- Treatment with oral corticosteroids resulting in a reduction of inflammation, followed by an increase in inflammation (of at least 1 grade in anterior chamber cells or vitreous haze or a change of non-active to active lesions) when corticosteroid is tapered, in the 180 weeks prior to enrollment
- Active inflammation after long-acting corticosteroid injection 4 weeks to 180 days prior to enrollment
- Active inflammation after treatment with >10mg/day oral prednisone for at least the past 90 days prior to enrollment
- Known chronic condition necessitating corticosteroid-sparing immunosuppressive treatment: Behcet's disease with posterior segment involvement, multifocal choroiditis with panuveitis, serpiginous choroidopathy, birdshot retinochoroidopathy, diffuse retinal vasculitis, Vogt-Koyanagi-Harada with bullous serous retinal detachments and/or choroidal detachments, sympathetic ophthalmia. No prior therapy required for these patients
Willingness to start corticosteroid treatment at 1mg/kg or 60mg a day of prednisone, whichever is less
Willingness to limit alcohol consumption
Willingness to use an acceptable method of contraception during the study period (i.e. pharmacologics, devices, barrier methods) or abstinence.
- Exclusion Criteria: Any of the following
Any infectious cause of uveitis
Prior immunosuppressive therapy other than corticosteroids in the past 12 months
Prior intolerability or safety issues with methotrexate or mycophenolate mofetil
Prior failure to control ocular or other inflammation using methotrexate or mycophenolate mofetil
Prior biologic therapy at any time
Media opacity (such as cataract and/or corneal scar) and/or extensive posterior synechiae such that examination of the posterior segment is not possible in both eyes
Chronic hypotony (IOP < 5 mm Hg for > 3 months) in both eyes
Periocular or intravitreal corticosteroid injection in the past 4 weeks
Fluocinolone acetonide implant in either eye in < 3 years
Intraocular surgery in < 30 days, or planning on getting surgery within the next 6 months
Best spectacle-corrected visual acuity (BSCVA) of hand motions or worse in better eye
< 16 years of age at enrollment
Planning to conceive during the study period, pregnant or breast-feeding (blood or urine pregnancy test for all females, excluding those who are post-menopausal is mandatory)*
Any history of cancer (If a patient has a history of non-melanoma skin cancer they can still be considered for inclusion in this study, provided it is not currently active).
Systemic autoimmune disease anticipated to dictate treatment course
Abnormal Complete blood count (≤ 2,500 white blood cells and/or ≤ 75,000 platelets and/or ≤9 hemoglobin) within 4 weeks prior to enrollment*
Abnormal alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) ≥ 2 times the upper limit of normal for the lab and/or creatinine ≥ 1.5 within 4 weeks prior to enrollment*
Evidence of active tuberculosis, HIV infection, syphilis, or hepatitis B or C (patients must have a tuberculin skin test, or interferon-gamma release assay, a chest radiograph, RPR/VDRL, FTA-ABS, or other treponemal tests, Hepatitis B surface antigen, Hepatitis C antibody tests, and HIV test within 90 days prior to enrollment)**
*Testing required within 4 weeks prior to enrollment; **Testing required within 90 days prior to enrollment.
Sites / Locations
- Francis I Proctor Foundation
- Northwestern University
- Oregon Health and Science University - Casey Eye Institute
- Royal Victorian Eye and Ear Hospital
- Aravind Eye Hospital
- Aravind Eye Hospital
- Aravind Eye Hospital
- Asociacion Para Evita La Ceguera en Mexico
- King Khaled Eye Specialist Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Methotrexate
Mycophenolate Mofetil
oral methotrexate
oral mycophenolate mofetil