Oral vs topical antifungals for corneal ulcers - MUTT ado about nothing? Following MUTT I, in which topical natamycin demonstrated superior efficacy compared to topical voriconazole, the Mycotic Ulcer Treatment Trial II was designed to determine the benefit of oral voriconazole in addition to topical antifungal regimens in cases of severe mycotic keratitis. 240 patients from 6 clinical sites in Nepal and India were randomized to the oral voriconazole treatment group (n=119) and the control, placebo group (n=121); both received topical natamycin and topical voriconazole.
Overall, the MUTT II demonstrated that oral voriconazole did lead to an appreciable decrease in the rates of perforation or need for therapeutic penetrating keratoplasty. in fact, its use was associated with increased risk for adverse events. Given the drug’s high-cost profile as well, adjunct oral voriconazole was not recommended in the treatment of mycotic keratitis after this study.
- Oral voriconazole did lead to a statistically significant reduction in the rate of corneal perforation or need for therapeutic penetrating keratoplasty (HR 0.82, 95% CI, 0.57-1.18, P=0.29)
- No significant improvement in the mean BSCVA of the oral voriconazole group after 3 months of follow-up
- A total of 58 adverse events (48.7%) were recorded in the PO voriconazole arm vs. 28 adverse events (23.1%) in the placebo group