Combination of Steroids and MMF in Autoimmune Uveitis: No Contraindications
There are no contraindications to using steroids and mycophenolate mofetil (MMF) together in autoimmune uveitis—this combination is explicitly recommended and widely used as standard practice. 1
Evidence Supporting Combined Use
The combination of MMF with corticosteroids is an established treatment approach for noninfectious uveitis:
MMF has a Grade B recommendation (EL 2B) for treating noninfectious uveitis, with evidence demonstrating inflammation control, steroid-sparing effect, and visual acuity improvement in most patients. 1
In clinical studies, 95 out of 106 patients (90%) with uveitis were successfully treated with MMF combined with prednisolone at doses of 2.5-10 mg daily, with only 8 patients requiring MMF monotherapy. 2
The combination is well-tolerated, with low rates of discontinuation due to adverse events (typically <10%). 1
Actual Contraindications to MMF
The only true contraindication to MMF is:
- Hypersensitivity to mycophenolate mofetil, mycophenolic acid, or any component of the drug product. 3
Important Safety Considerations (Not Contraindications)
While not contraindications to combined use with steroids, monitor for:
Embryofetal toxicity: MMF causes fetal harm and is associated with increased risk of first trimester pregnancy loss and congenital malformations. Females of reproductive potential require pregnancy testing and effective contraception. 3
Increased infection risk: The combination of immunosuppressants increases susceptibility to bacterial, fungal, protozoal, and viral infections including opportunistic infections, but this is an expected risk requiring monitoring rather than a contraindication. 3
Neutropenia: Severe neutropenia (ANC <0.5 x 10³/µL) developed in up to 3.6% of patients on MMF. Monitor complete blood counts and interrupt or reduce dosing if ANC <1.3 x 10³/µL. 3
Gastrointestinal side effects: The most common adverse effect is gastrointestinal upset (15% of patients), which may require dose reduction but rarely necessitates discontinuation. 2
Clinical Outcomes with Combined Therapy
In pediatric uveitis, MMF with steroids achieved a steroid-sparing effect in 88% of patients, with oral prednisolone successfully discontinued in 41% and reduced to ≤5 mg daily in 47%. 4
Visual acuity remained stable or improved in 94.2% of patients treated with MMF, demonstrating preservation of quality of life. 5
Even when dose reduction is required for tolerability, treatment success rates remain high (74% vs 58% at full dose), with the odds ratio favoring dose reduction (OR 1.60, though not statistically significant). 6
Common Pitfall to Avoid
Do not confuse the need for careful monitoring with a contraindication. The increased infection risk and potential for neutropenia with combined immunosuppression requires vigilance but does not preclude using steroids with MMF—this combination is the therapeutic standard for achieving steroid-free remission in autoimmune uveitis. 1