BACKGROUND: Multiple immunosuppressive drugs have been used to manage inflammatory eye disease when control cannot be achieved by corticosteroid alone. However, although clinical studies support the effectiveness of most of these agents, comparative studies have not been undertaken. Retention time, a measure of the duration of treatment with any given drug, is a crude indicator of drug effectiveness and tolerability that facilitates such a comparison. The retention time was compared for corticosteroid-sparing immunosuppressive agents in patients attending our tertiary referral inflammatory eye disease clinic. METHODS: The clinical records of all patients attending an inflammatory eye disease clinic at the Casey Eye Institute over a 1-year period (2003) were reviewed. From these records, we collected the following clinical data: age; sex; ocular diagnosis; and use of steroid-sparing systemic immunosuppression, including drugs, duration of treatment and, if ceased, reasons for cessation. Cox regression analysis, adjusted for clustering, was used to compare other drugs against methotrexate. RESULTS: 107 of 302 (35%) patients seen at the inflammatory eye disease clinic in 2003 had a total of 193 current or past prescriptions for systemic steroid-sparing immunosuppressive agents. The treated group, most of whom had uveitis, included 32 men and 75 women, aged 5-86 years. Most commonly prescribed were methotrexate (66 uses, 34%), ciclosporin (37 uses, 19%), azathioprine (26 uses, 13%), mycophenolate mofetil (22 uses, 11%) and cyclophosphamide (15 uses, 8%). Patients were retained significantly less on ciclosporin (p = 0.004), azathioprine (p = 0.04), mycophenolate mofetil (p = 0.04) and cyclophosphamide (p<0.001) compared with methotrexate. Reasons for cessation included adverse events, lack of effectiveness, success or remission, cost and desire for fertility. CONCLUSIONS: In patients with inflammatory eye disease, methotrexate may offer a superior combination of effectiveness and tolerability over other commonly used corticosteroid-sparing immunosuppressive agents. In this study, there was a twofold risk of not being retained on azathioprine, mycophenolate mofetil and ciclosporin and a fourfold risk of not being retained on cyclophosphamide compared with methotrexate.
BACKGROUND: Multiple immunosuppressive drugs have been used to manage inflammatory eye disease when control cannot be achieved by corticosteroid alone. However, although clinical studies support the effectiveness of most of these agents, comparative studies have not been undertaken. Retention time, a measure of the duration of treatment with any given drug, is a crude indicator of drug effectiveness and tolerability that facilitates such a comparison. The retention time was compared for corticosteroid-sparing immunosuppressive agents in patients attending our tertiary referral inflammatory eye disease clinic. METHODS: The clinical records of all patients attending an inflammatory eye disease clinic at the Casey Eye Institute over a 1-year period (2003) were reviewed. From these records, we collected the following clinical data: age; sex; ocular diagnosis; and use of steroid-sparing systemic immunosuppression, including drugs, duration of treatment and, if ceased, reasons for cessation. Cox regression analysis, adjusted for clustering, was used to compare other drugs against methotrexate. RESULTS: 107 of 302 (35%) patients seen at the inflammatory eye disease clinic in 2003 had a total of 193 current or past prescriptions for systemic steroid-sparing immunosuppressive agents. The treated group, most of whom had uveitis, included 32 men and 75 women, aged 5-86 years. Most commonly prescribed were methotrexate (66 uses, 34%), ciclosporin (37 uses, 19%), azathioprine (26 uses, 13%), mycophenolate mofetil (22 uses, 11%) and cyclophosphamide (15 uses, 8%). Patients were retained significantly less on ciclosporin (p = 0.004), azathioprine (p = 0.04), mycophenolate mofetil (p = 0.04) and cyclophosphamide (p<0.001) compared with methotrexate. Reasons for cessation included adverse events, lack of effectiveness, success or remission, cost and desire for fertility. CONCLUSIONS: In patients with inflammatory eye disease, methotrexate may offer a superior combination of effectiveness and tolerability over other commonly used corticosteroid-sparing immunosuppressive agents. In this study, there was a twofold risk of not being retained on azathioprine, mycophenolate mofetil and ciclosporin and a fourfold risk of not being retained on cyclophosphamide compared with methotrexate.
Authors: H Yazici; H Pazarli; C G Barnes; Y Tüzün; Y Ozyazgan; A Silman; S Serdaroğlu; V Oğuz; S Yurdakul; G E Lovatt Journal: N Engl J Med Date: 1990-02-01 Impact factor: 91.245
Authors: Conor C Murphy; Kathrin Greiner; Jarka Plskova; Linda Duncan; Andrew Frost; John D Isaacs; Peppy Rebello; Herman Waldmann; Geoff Hale; John V Forrester; Andrew D Dick Journal: Arch Ophthalmol Date: 2004-06
Authors: Sapna S Gangaputra; Craig W Newcomb; Marshall M Joffe; Kurt Dreger; Hosne Begum; Pichaporn Artornsombudh; Siddharth S Pujari; Ebenezer Daniel; H Nida Sen; Eric B Suhler; Jennifer E Thorne; Nirali P Bhatt; C Stephen Foster; Douglas A Jabs; Robert B Nussenblatt; James T Rosenbaum; Grace A Levy-Clarke; John H Kempen Journal: Am J Ophthalmol Date: 2019-07-22 Impact factor: 5.258
Authors: Arpita S Bharadwaj; Binoy Appukuttan; Phillip A Wilmarth; Yuzhen Pan; Andrew J Stempel; Timothy J Chipps; Eric E Benedetti; David O Zamora; Dongseok Choi; Larry L David; Justine R Smith Journal: Prog Retin Eye Res Date: 2012-09-11 Impact factor: 21.198
Authors: Sapna Gangaputra; Craig W Newcomb; Teresa L Liesegang; R Oktay Kaçmaz; Douglas A Jabs; Grace A Levy-Clarke; Robert B Nussenblatt; James T Rosenbaum; Eric B Suhler; Jennifer E Thorne; C Stephen Foster; John H Kempen Journal: Ophthalmology Date: 2009-09-12 Impact factor: 12.079
Authors: Ana Belen Rivas; Amanda Lopez-Picado; Valentina Calamia; Ester Carreño; Lidia Cocho; Miguel Cordero-Coma; Alex Fonollosa; Felix M Francisco Hernandez; Angel Garcia-Aparicio; Javier Garcia-Gonzalez; Jose Juan Mondejar; Leticia Lojo-Oliveira; Llucí Martínez-Costa; Santiago Munoz; Diana Peiteado; Jose Antonio Pinto; Beatriz Rodriguez-Lozano; Esperanza Pato; David Diaz-Valle; Elena Molina; Luis Alberto Tebar; Luis Rodriguez-Rodriguez Journal: BMJ Open Date: 2022-03-22 Impact factor: 2.692