Lydia Abásolo1, Zulema Rosales2, David Díaz-Valle3, Alejandro Gómez-Gómez2, Rayma C Peña-Blanco2, Ángela Prieto-García2, José Manuel Benítez-Del-Castillo3, Esperanza Pato2, Julián García-Feijoo3, Benjamín Fernández-Gutiérrez4, Luis Rodriguez-Rodriguez4. 1. Rheumatology Department, Hospital Clínico San Carlos, Madrid, Spain; Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain. Electronic address: labasolo@salud.madrid.org. 2. Rheumatology Department, Hospital Clínico San Carlos, Madrid, Spain. 3. Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain; Ophthalmology Department, Hospital Clínico San Carlos, Madrid, Spain; Cooperative Research Network on Age-Related Ocular Pathology, Visual and Life Quality, Instituto de Salud Carlos III, Madrid, Spain. 4. Rheumatology Department, Hospital Clínico San Carlos, Madrid, Spain; Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain.
Abstract
PURPOSE: To assess in uveitis patients the rate of immunosuppressive drug (ISD) discontinuation in real-life clinical practice, comparing this rate among ISDs. DESIGN: Longitudinal retrospective cohort study. METHODS: We included uveitis patients attending a tertiary eye referral center from Madrid (Spain) between 1989 and 2015, prescribed any ISDs (cyclosporine, methotrexate, azathioprine, anti-TNF drugs, or others). Our main outcome was discontinuation of all ISDs owing to clinical efficacy, inefficacy, adverse drug reaction (ADR), and other medical causes. Discontinuation rates (DRs) per 100 patient-years were estimated. Variables associated with specific-cause discontinuations were analyzed using Cox bivariate and multivariate models. RESULTS: We analyzed 110 patients with 263 treatment courses and 665.2 patient-years of observation. Cyclosporine (66.4%), methotrexate (47.3%), azathioprine (30.9%), and anti-TNFs (30.9%) were the most frequently used ISDs. Treatment was suspended in 136 cases (mostly owing to clinical efficacy [38.2%], inefficacy [26.5%], and ADRs [22.8%]). All-cause DR with 95% confidence interval was 20.4 [17.3-24.2]. Retention rates at 1 and 10 years were 74% and 16%, respectively. In the multivariate analysis, combined treatment exhibited higher DRs owing to clinical efficacy than other ISDs in monotherapy. Conversely, nonbiologic combination therapy with azathioprine exhibited the highest DR owing to ADRs. CONCLUSIONS: Clinical efficacy was the most frequent cause for ISD discontinuation, followed by inefficacy and ADRs. DR owing to efficacy was higher for combination therapy. Furthermore, nonbiologic combination therapy with azathioprine was associated with a higher DR owing to ADRs.
PURPOSE: To assess in uveitispatients the rate of immunosuppressive drug (ISD) discontinuation in real-life clinical practice, comparing this rate among ISDs. DESIGN: Longitudinal retrospective cohort study. METHODS: We included uveitispatients attending a tertiary eye referral center from Madrid (Spain) between 1989 and 2015, prescribed any ISDs (cyclosporine, methotrexate, azathioprine, anti-TNF drugs, or others). Our main outcome was discontinuation of all ISDs owing to clinical efficacy, inefficacy, adverse drug reaction (ADR), and other medical causes. Discontinuation rates (DRs) per 100 patient-years were estimated. Variables associated with specific-cause discontinuations were analyzed using Cox bivariate and multivariate models. RESULTS: We analyzed 110 patients with 263 treatment courses and 665.2 patient-years of observation. Cyclosporine (66.4%), methotrexate (47.3%), azathioprine (30.9%), and anti-TNFs (30.9%) were the most frequently used ISDs. Treatment was suspended in 136 cases (mostly owing to clinical efficacy [38.2%], inefficacy [26.5%], and ADRs [22.8%]). All-cause DR with 95% confidence interval was 20.4 [17.3-24.2]. Retention rates at 1 and 10 years were 74% and 16%, respectively. In the multivariate analysis, combined treatment exhibited higher DRs owing to clinical efficacy than other ISDs in monotherapy. Conversely, nonbiologic combination therapy with azathioprine exhibited the highest DR owing to ADRs. CONCLUSIONS: Clinical efficacy was the most frequent cause for ISD discontinuation, followed by inefficacy and ADRs. DR owing to efficacy was higher for combination therapy. Furthermore, nonbiologic combination therapy with azathioprine was associated with a higher DR owing to ADRs.
Authors: Claudia Fabiani; Antonio Vitale; Giacomo Emmi; Alice Bitossi; Giuseppe Lopalco; Jurgen Sota; Silvana Guerriero; Ida Orlando; Marco Capozzoli; Fiorella Fusco; Francesco Rana; Florenzo Iannone; Bruno Frediani; Mauro Galeazzi; Lorenzo Vannozzi; Gian Marco Tosi; Luca Cantarini Journal: Clin Rheumatol Date: 2018-04-03 Impact factor: 2.980
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