Rupesh Agrawal1, Julio J Gonzalez-Lopez2, João Nobre-Cardoso2, Bhaskar Gupta3, Robert Grant4, Peter K F Addison2, Mark Westcott2, Carlos E Pavesio5. 1. Department of Medical Retina, Moorfields Eye Hospital, NHS Foundation Trust, London, UK Biomedical Research Centre, UCL Institute of Ophthalmology, London, UK Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore. 2. Department of Medical Retina, Moorfields Eye Hospital, NHS Foundation Trust, London, UK. 3. Department of Medical Retina, Royal Devon and Exeter NHS Trust, Exeter, UK. 4. St George's, University of London & Kingston University, Kingston, UK. 5. Department of Medical Retina, Moorfields Eye Hospital, NHS Foundation Trust, London, UK Biomedical Research Centre, UCL Institute of Ophthalmology, London, UK.
Abstract
AIM: To assess the impact of antitubercular therapy (ATT), oral steroids and steroid sparing immunosuppressive treatment on treatment success in cases with presumed ocular tuberculosis in an area of low endemic prevalence. METHODS: A retrospective cross-sectional study was performed for 213 patients with presumed ocular tuberculosis from a database from a tertiary referral eye hospital in the UK. A logistic regression model was constructed incorporating demographics, baseline characteristics and different cut-offs of QuantiFERON-TB Gold In-Tube test (QFT-G) to identify significant factors accounting for the variability of the response variable ('failure') across the whole group. Treatment failure was defined as the recurrence of inflammation or inability to taper steroids within 6 months of completion of ATT or after at least 6 months of treatment in the non-ATT group. RESULTS: There were 126 patients who had at least 6 months of ATT. Patients with QFT-G values >1.50 (OR=0.20, 95% CI 0.09 to 0.48, p<0.001) had less risk of treatment failure as against those with QFT-G values between 0.35 and 1.50. Steroid sparing immunosuppressive agents reduced the chances of treatment success (OR=24.10, 95% CI 6.75 to 86.11, p<0.001). This effect persisted even after adjusting for potential confounding factors. CONCLUSIONS: Patients with higher values of QFT-G (>1.5) are more likely to have treatment success with ATT. In our model, steroid sparing immunosuppressive agents reduced the chances of success in both ATT and non-ATT-treated patients. It is unclear whether this effect reflects the intrinsic underlying severity of disease (ie, study bias), or whether steroid sparing immunosuppressive agents mitigate against successful ATT. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
AIM: To assess the impact of antitubercular therapy (ATT), oral steroids and steroid sparing immunosuppressive treatment on treatment success in cases with presumed ocular tuberculosis in an area of low endemic prevalence. METHODS: A retrospective cross-sectional study was performed for 213 patients with presumed ocular tuberculosis from a database from a tertiary referral eye hospital in the UK. A logistic regression model was constructed incorporating demographics, baseline characteristics and different cut-offs of QuantiFERON-TB Gold In-Tube test (QFT-G) to identify significant factors accounting for the variability of the response variable ('failure') across the whole group. Treatment failure was defined as the recurrence of inflammation or inability to taper steroids within 6 months of completion of ATT or after at least 6 months of treatment in the non-ATT group. RESULTS: There were 126 patients who had at least 6 months of ATT. Patients with QFT-G values >1.50 (OR=0.20, 95% CI 0.09 to 0.48, p<0.001) had less risk of treatment failure as against those with QFT-G values between 0.35 and 1.50. Steroid sparing immunosuppressive agents reduced the chances of treatment success (OR=24.10, 95% CI 6.75 to 86.11, p<0.001). This effect persisted even after adjusting for potential confounding factors. CONCLUSIONS:Patients with higher values of QFT-G (>1.5) are more likely to have treatment success with ATT. In our model, steroid sparing immunosuppressive agents reduced the chances of success in both ATT and non-ATT-treated patients. It is unclear whether this effect reflects the intrinsic underlying severity of disease (ie, study bias), or whether steroid sparing immunosuppressive agents mitigate against successful ATT. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: J J González-López; Á M García-Aparicio; D Sánchez-Ponce; N Muñoz-Sanz; N Fernandez-Ledo; P Beneyto; M C Westcott Journal: Eye (Lond) Date: 2016-04-08 Impact factor: 3.775
Authors: R La Distia Nora; R Sitompul; M Bakker; M Susiyanti; L Edwar; S Sjamsoe; G Singh; M P van Hagen; A Rothova Journal: Eye (Lond) Date: 2017-11-03 Impact factor: 3.775
Authors: Erika Marie Damato; Sarah Dawson; Xiaoxuan Liu; Chandoshi Mukherjee; John Horsburgh; Alastair K Denniston; Edward Moran; Martin Dedicoat; Philip Ian Murray Journal: J Ophthalmic Inflamm Infect Date: 2017-12-04