Quality-of-Life Outcomes From a Randomized Clinical Trial Comparing Antimetabolites for Intermediate, Posterior, and Panuveitis

Abstract

To evaluate the changes in quality of life in noninfectious uveitis patients treated with 2 of the most commonly prescribed antimetabolite treatments. Secondary analysis of a multicenter, block-randomized clinical trial. Eighty patients at Aravind Eye Hospitals in Madurai and Coimbatore, India, with noninfectious intermediate, posterior, or panuveitis were randomized to receive oral methotrexate, 25mg weekly, or oral mycophenolate mofetil, 1g twice daily, and were followed up monthly for 6months. Best-corrected visual acuity, Indian Vision Function Questionnaire (IND-VFQ), and Medical Outcomes Study 36-item Short Form Survey (SF-36) were obtained at enrollment and at 6months (or prior, in the event of early treatment failure). IND-VFQ scores, on average, increased by 9.2 points from trial enrollment to 6months (95% confidence interval [CI]: 4.9, 13.5, P= .0001). Although the SF-36 physical component summary score did not significantly differ over the course of the trial, the mental component summary score decreased by 2.3 points (95% CI:-4.4,-0.1, P= .04) and the vitality subscale decreased by 3.5 points (95% CI:-5.6,-1.4, P=.001). Quality-of-life scores did not differ between treatment arms. Linear regression modeling showed a 3.2-point improvement in IND-VFQ score for every 5-letter improvement in visual acuity (95% CI: 1.9, 4.3; P < .001). Although uveitis treatment was associated with increased vision and vision-related quality of life, patient-reported physical health did not change after 6months of treatment, and mental health decreased. Despite improved visual outcomes, uveitis patients receiving systemic immunosuppressive therapy may experience a deterioration in mental health-related quality of life.