Katherine M Niemeyer1, John A Gonzales2, Sivakumar R Rathinam3, Manohar Babu4, Radhika Thundikandy3, Anuradha Kanakath4, Travis C Porco5, Erica N Browne1, Maya M Rao1, Nisha R Acharya6. 1. F. I. Proctor Foundation, University of California, San Francisco, San Francisco, California. 2. F. I. Proctor Foundation, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California. 3. Aravind Eye Care System, Madurai, India. 4. Aravind Eye Care System, Coimbatore, India. 5. F. I. Proctor Foundation, University of California, San Francisco, San Francisco, California; Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California. 6. F. I. Proctor Foundation, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California. Electronic address: nisha.acharya@ucsf.edu.
Abstract
PURPOSE: To evaluate the changes in quality of life in noninfectious uveitis patients treated with 2 of the most commonly prescribed antimetabolite treatments. DESIGN: Secondary analysis of a multicenter, block-randomized clinical trial. METHODS:Eighty patients at Aravind Eye Hospitals in Madurai and Coimbatore, India, with noninfectious intermediate, posterior, or panuveitis were randomized to receive oral methotrexate, 25 mg weekly, or oral mycophenolate mofetil, 1 g twice daily, and were followed up monthly for 6 months. 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 6 months (or prior, in the event of early treatment failure). RESULTS:IND-VFQ scores, on average, increased by 9.2 points from trial enrollment to 6 months (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). CONCLUSIONS: Although uveitis treatment was associated with increased vision and vision-related quality of life, patient-reported physical health did not change after 6 months of treatment, and mental health decreased. Despite improved visual outcomes, uveitis patients receivingsystemic immunosuppressive therapy may experience a deterioration in mental health-related quality of life.
RCT Entities:
PURPOSE: To evaluate the changes in quality of life in noninfectious uveitispatients treated with 2 of the most commonly prescribed antimetabolite treatments. DESIGN: Secondary analysis of a multicenter, block-randomized clinical trial. METHODS: Eighty patients at Aravind Eye Hospitals in Madurai and Coimbatore, India, with noninfectious intermediate, posterior, or panuveitis were randomized to receive oral methotrexate, 25 mg weekly, or oral mycophenolate mofetil, 1 g twice daily, and were followed up monthly for 6 months. 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 6 months (or prior, in the event of early treatment failure). RESULTS: IND-VFQ scores, on average, increased by 9.2 points from trial enrollment to 6 months (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). CONCLUSIONS: Although uveitis treatment was associated with increased vision and vision-related quality of life, patient-reported physical health did not change after 6 months of treatment, and mental health decreased. Despite improved visual outcomes, uveitispatients receiving systemic immunosuppressive therapy may experience a deterioration in mental health-related quality of life.
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Authors: Nicole K Kelly; Aheli Chattopadhyay; S R Rathinam; John A Gonzales; Radhika Thundikandy; Anuradha Kanakath; S Bala Murugan; R Vedhanayaki; Dean Cugley; Lyndell L Lim; Eric B Suhler; Hassan A Al-Dhibi; Caleb D Ebert; Elyse J Berlinberg; Travis C Porco; Nisha R Acharya Journal: Ophthalmology Date: 2021-03-04 Impact factor: 14.277