TY - JOUR
T1 - Comparison of Antimetabolite Drugs as Corticosteroid-Sparing Therapy for Noninfectious Ocular Inflammation
AU - Galor, Anat
AU - Jabs, Douglas A.
AU - Leder, Henry A.
AU - Kedhar, Sanjay R.
AU - Dunn, James P.
AU - Peters, George B.
AU - Thorne, Jennifer E.
N1 - Funding Information:
Supported by grants EY-13707 (Dr Thorne) and EY-00405 (Dr Jabs) from the National Eye Institute, Bethesda, Maryland, and unrestricted funds from Research to Prevent Blindness (Dr Galor). Dr Thorne is the recipient of a Research to Prevent Blindness Harrington Special Scholars Award.
Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2008/10
Y1 - 2008/10
N2 - Purpose: To compare the relative effectiveness and side effect profiles of antimetabolite drugs in the treatment of noninfectious ocular inflammation. Design: Retrospective cohort study. Participants: A total of 257 patients with inflammatory eye disease seen in a single-center, academic practice and treated with an antimetabolite as a first-line immunosuppressive agent from 1984 to 2006. Methods: Data recorded included demographics, antimetabolite and prednisone doses, use of other immunosuppressive drugs, response to therapy, and side effects associated with drug use. Main Outcome Measures: Ability to control ocular inflammation and to taper prednisone to ≤10 mg daily ("treatment success"); incidence of treatment-related side effects. Results: Ninety patients with inflammatory eye disease were treated with methotrexate, 38 patients were treated with azathioprine, and 129 patients were treated with mycophenolate. Uveitis accounted for the majority of the diagnoses (67%, 66%, and 68% for methotrexate, azathioprine, and mycophenolate, respectively), followed by scleritis (23%, 18%, 17% for methotrexate, azathioprine, and mycophenolate, respectively). The median time to treatment success was 4.0, 4.8, and 6.5 months for the mycophenolate, azathioprine, and methotrexate treatment groups, respectively (P = 0.02, log-rank test). The incidence of side effects was higher in the azathioprine group (0.29/person-year [PY]) compared with patients treated with methotrexate (0.14/PY) and mycophenolate (0.18/PY). More patients discontinued the drug because of side effects in the azathioprine group (0.24/PY vs 0.09/PY for the methotrexate group and 0.09/PY for the mycophenolate mofetil group). Conclusions: These data suggest that the time to control of ocular inflammation is faster with mycophenolate than with methotrexate. Azathioprine therapy has a higher rate of treatment-related side effects compared with the other 2 agents. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.
AB - Purpose: To compare the relative effectiveness and side effect profiles of antimetabolite drugs in the treatment of noninfectious ocular inflammation. Design: Retrospective cohort study. Participants: A total of 257 patients with inflammatory eye disease seen in a single-center, academic practice and treated with an antimetabolite as a first-line immunosuppressive agent from 1984 to 2006. Methods: Data recorded included demographics, antimetabolite and prednisone doses, use of other immunosuppressive drugs, response to therapy, and side effects associated with drug use. Main Outcome Measures: Ability to control ocular inflammation and to taper prednisone to ≤10 mg daily ("treatment success"); incidence of treatment-related side effects. Results: Ninety patients with inflammatory eye disease were treated with methotrexate, 38 patients were treated with azathioprine, and 129 patients were treated with mycophenolate. Uveitis accounted for the majority of the diagnoses (67%, 66%, and 68% for methotrexate, azathioprine, and mycophenolate, respectively), followed by scleritis (23%, 18%, 17% for methotrexate, azathioprine, and mycophenolate, respectively). The median time to treatment success was 4.0, 4.8, and 6.5 months for the mycophenolate, azathioprine, and methotrexate treatment groups, respectively (P = 0.02, log-rank test). The incidence of side effects was higher in the azathioprine group (0.29/person-year [PY]) compared with patients treated with methotrexate (0.14/PY) and mycophenolate (0.18/PY). More patients discontinued the drug because of side effects in the azathioprine group (0.24/PY vs 0.09/PY for the methotrexate group and 0.09/PY for the mycophenolate mofetil group). Conclusions: These data suggest that the time to control of ocular inflammation is faster with mycophenolate than with methotrexate. Azathioprine therapy has a higher rate of treatment-related side effects compared with the other 2 agents. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.
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U2 - 10.1016/j.ophtha.2008.04.026
DO - 10.1016/j.ophtha.2008.04.026
M3 - Article
C2 - 18579209
AN - SCOPUS:52949152867
VL - 115
SP - 1826
EP - 1832
JO - Ophthalmology
JF - Ophthalmology
SN - 0161-6420
IS - 10
ER -