| Methotrexate for ocular inflammatory diseases. | |
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MedLine Citation:
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PMID: 19748676 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: To evaluate the outcome of treatment with methotrexate for noninfectious ocular inflammation. DESIGN: Retrospective cohort study. PARTICIPANTS: Patients with noninfectious ocular inflammation managed at 4 tertiary ocular inflammation clinics in the United States observed to add methotrexate as a single, noncorticosteroid immunosuppressive agent to their treatment regimen, between 1979 and 2007, inclusive. METHODS: Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics, including dosage, route of administration of methotrexate, and main outcome measures, were obtained for every eye of every patient at every visit via medical record review by trained expert reviewers. MAIN OUTCOME MEASURES: Control of inflammation, corticosteroid-sparing effects, and incidence of and reason for discontinuation of therapy. RESULTS: Among 384 patients (639 eyes) observed from the point of addition of methotrexate to an anti-inflammatory regimen, 32.8%, 9.9%, 21.4%, 14.6%, 15.1%, and 6.3%, respectively, had anterior uveitis, intermediate uveitis, posterior or panuveitis, scleritis, ocular mucous membrane pemphigoid, and other forms of ocular inflammation. In these groups, complete suppression of inflammation sustained for >or=28 days was achieved within 6 months in 55.6%, 47.4%, 38.6%, 56.4%, 39.5%, and 76.7%, respectively. Corticosteroid-sparing success (sustained suppression of inflammation with prednisone <or=10 mg/d) was achieved within 6 months among 46.1%, 41.3%, 20.7%, 37.3%, 36.5%, and 50.9%, respectively. Overall, success within 12 months was 66% and 58.4% for sustained control and corticosteroid sparing (<or=10 mg), respectively. Methotrexate was discontinued within 1 year by 42% of patients. It was discontinued owing to ineffectiveness in 50 patients (13%); 60 patients (16%) discontinued because of side effects, which typically were reversible with dose reduction or discontinuation. Remission was seen in 43 patients, with 7.7% remitting within 1 year of treatment. CONCLUSIONS: Our data suggest that adding methotrexate to an anti-inflammatory regimen not involving other noncorticosteroid immunosuppressive drugs is moderately effective for management of inflammatory activity and for achieving corticosteroid-sparing objectives, although many months may be required for therapeutic success. Methotrexate was well tolerated by most patients, and seems to convey little risk of serious side effects during treatment. |
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Authors:
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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; |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2009-09-12 |
Journal Detail:
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Title: Ophthalmology Volume: 116 ISSN: 1549-4713 ISO Abbreviation: Ophthalmology Publication Date: 2009 Nov |
Date Detail:
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Created Date: 2009-11-03 Completed Date: 2009-11-12 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7802443 Medline TA: Ophthalmology Country: United States |
Other Details:
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Languages: eng Pagination: 2188-98.e1 Citation Subset: IM |
Affiliation:
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Department of Ophthalmology, The Fundus Photograph Reading Center, University of Wisconsin, Madison, Wisconsin, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Child Child, Preschool Conjunctival Diseases / drug therapy* Female Humans Immunosuppressive Agents / therapeutic use* Inflammation / drug therapy Male Methotrexate / therapeutic use* Middle Aged Pemphigoid, Benign Mucous Membrane / drug therapy* Retrospective Studies Scleritis / drug therapy* Treatment Outcome Uveitis / drug therapy* Visual Acuity |
| Grant Support | |
ID/Acronym/Agency:
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EY014943/EY/NEI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Immunosuppressive Agents; 59-05-2/Methotrexate |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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