Methotrexate

The FAST trial randomised 216 adults with non-infectious uveitis to methotrexate 25 mg weekly or mycophenolate 3 g daily. Treatment success at 6 months was 66.7% on methotrexate against 57.1% on mycophenolate, which did not reach significance overall (odds ratio 1.50, 95% CI 0.81 to 2.81, p=0.20). The useful finding is the split by anatomy: methotrexate was better for posterior uveitis and panuveitis (74.4% against 55.3%, p=0.02) while mycophenolate was better for intermediate uveitis (63.6% against 33.3%, p=0.07), and the interaction between drug and subtype was significant at p=0.004. Raised liver enzymes were the commonest laboratory problem, in 13.0% on methotrexate.