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Mycotic Ulcer Treatment Trial (MUTT)

April, 2013

Clinical Trial

The mycotic ulcer treatment trial: a randomized trial comparing natamycin vs voriconazole.

Prajna NV, Krishnan T, Mascarenhas J, Rajaraman R, Prajna L, Srinivasan M, Raghavan A, Oldenburg CE, Ray KJ, Zegans ME, McLeod SD, Porco TC, Acharya NR, Lietman TM; Mycotic Ulcer Treatment Trial Group.

JAMA Ophthalmol. 2013 Apr;131(4):422-9.
Full text | Metrics.

Main finding: There was no benefit (rate of corneal perforation/need for PK) to adding oral voriconazole to topical antifungal eyedrops in the treatment of severe filamentous fungal ulcers.

 

  • Purpose: To compare topical natamycin vs voriconazole in the treatment of filamentous fungal keratitis.
  • Study type: Randomized controlled Trial
  • Condition: Fungal keratitis

Participants: Filamentous fungal ulcer, visual acuity of 20/40 to 20/400.

 

  • n=323 (MUTT-1)

 

Intervention:

 

Group 1: Topical voriconazole 1%
Group 2: Topical natamycin 5%

 

Regime: Topically every hour while awake until re-epithelialisation, then QID for at least 3 weeks.

Natamycin-treated cases had significantly better BCVA, decreased risk of perforation or need for therapeutic penetrating keratoplasty.

 

Fusarium cases on natamycin had better visual outcomes but similar risk of perforation


Main finding:

 

Natamycin was associated with significantly better clinical outcomes than voriconazole for filamentous fungal keratitis, especially in Fusarium cases; Do not use voriconazole as monotherapy in filamentous keratitis

 

There was no benefit (rate of corneal perforation/need for PK) to adding oral voriconazole to topical antifungal eyedrops in the treatment of severe filamentous fungal ulcers, except in Fusarium cases.

 

  • Study name: Mycotic Ulcer Treatment Trial (MUTT)
  • Study type: Randomised controlled Trial
  • Condition: Fungal keratitis

Participants: Filamentous fungal ulcer, visual acuity of 20/40 to 20/400.

 

  • n=323 (MUTT-1)

 

Intervention:

 

Group 1: Topical voriconazole 1%
Group 2: Topical natamycin 5%

Regime: Topically every hour while awake until re-epithelialisation, then QID for at least 3 weeks.

MUTT-1:

 

Natamycin-treated cases had significantly better BCVA, decreased risk of perforation or need for therapeutic penetrating keratoplasty.

 

Fusarium cases on natamycin had better visual outcomes but similar risk of perforation


MUTT II

Participants: Filamentous fungal ulcer, visual acuity 20/400 or worse

 

  • n=318

 

Intervention:

 

Topical antifungals and:
Group 1: oral voriconazole (400mg bd for 24 hours, then 200mg bd for 20 days.)

Group 2: placebo

 

Otherwise, continue IVA q8w

There was no benefit (rate of corneal perforation/need for PK) to adding oral voriconazole to topical antifungal eyedrops in the treatment of severe filamentous fungal ulcers.

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