Retention Time for Corticosteroid-Sparing Systemic Immunosuppressive Agents in Patients with Inflammatory Eye Disease.

Br J Ophthalmol. 2006 Aug 16; [Epub ahead of print]

• Baker KB,
• Spurrier NJ,
• Watkins AS,
• Smith JR,
• Rosenbaum JT.

Oregon Health & Science University, United States.

BACKGROUND: Multiple immunosuppressive medications have been used to manage inflammatory eye disease when control cannot be achieved by corticosteroid alone. However, while clinical studies support effectiveness of the majority of these agents, comparative studies have not been undertaken. Retention time, a measure of the duration of therapy with any given drug, is a crude indicator of drug effectiveness and tolerability that facilitates such a comparison. We compared the retention time for corticosteroid-sparing immunosuppressive agents in patients attending our tertiary referral inflammatory eye disease clinic. METHODS: We reviewed clinical records of all patients attending an inflammatory eye disease clinic at the Casey Eye Institute over a one year period (2003). From these records we collected the following clinical data: age; gender; ocular diagnosis; and use of steroid- sparing systemic immunosuppression, including drug(s), duration of therapy and, if ceased, reason(s) for cessation. Cox regression analysis, adjusted for clustering, was used to compare other medications against methotrexate. RESULTS: 107 of 302 patients (35%) 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, the majority of whom had uveitis, included 32 males and 75 females, aged 5 to 86 years. Most commonly prescribed were methotrexate (66 uses, 34%), cyclosporine (37 uses, 19%), azathioprine (26 uses, 13%), mycophenolate mofetil (22 uses, 11%), and cyclophosphamide (15 uses, 8%). Patients were retained statistically significantly less on cyclosporine (p = 0.004), azathioprine (p = 0.04), mycophenolate mofetil (p = 0.04), and cyclophosphamide (p = 0.0001) compared to methotrexate. Reasons for cessation included adverse events, lack of effectiveness, success/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 two-fold risk of not being retained on azathioprine, mycophenolate mofetil and cyclosporine and a four-fold risk of not being retained on cyclophosphamide compared to methotrexate.

PMID: 16914474 [PubMed - as supplied by publisher]