Comparison of Antimetabolite Drugs as Corticosteroid-Sparing Therapy for Noninfectious Ocular Inflammation

Anat Galor, Douglas A. Jabs, Henry A. Leder, Sanjay R. Kedhar, James P. Dunn, George B. Peters, Jennifer E. Thorne

Research output: Contribution to journalArticle

118 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1826-1832
Number of pages7
JournalOphthalmology
Volume115
Issue number10
DOIs
StatePublished - Oct 1 2008
Externally publishedYes

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Antimetabolites
Azathioprine
Methotrexate
Adrenal Cortex Hormones
Inflammation
Pharmaceutical Preparations
Eye Diseases
Therapeutics
Immunosuppressive Agents
Prednisone
Scleritis
Mycophenolic Acid
Aptitude
Incidence
Uveitis
Disclosure
Drug-Related Side Effects and Adverse Reactions
Cohort Studies
Retrospective Studies
Demography

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Galor, A., Jabs, D. A., Leder, H. A., Kedhar, S. R., Dunn, J. P., Peters, G. B., & Thorne, J. E. (2008). Comparison of Antimetabolite Drugs as Corticosteroid-Sparing Therapy for Noninfectious Ocular Inflammation. Ophthalmology, 115(10), 1826-1832. https://doi.org/10.1016/j.ophtha.2008.04.026

Comparison of Antimetabolite Drugs as Corticosteroid-Sparing Therapy for Noninfectious Ocular Inflammation. / Galor, Anat; Jabs, Douglas A.; Leder, Henry A.; Kedhar, Sanjay R.; Dunn, James P.; Peters, George B.; Thorne, Jennifer E.

In: Ophthalmology, Vol. 115, No. 10, 01.10.2008, p. 1826-1832.

Research output: Contribution to journalArticle

Galor, A, Jabs, DA, Leder, HA, Kedhar, SR, Dunn, JP, Peters, GB & Thorne, JE 2008, 'Comparison of Antimetabolite Drugs as Corticosteroid-Sparing Therapy for Noninfectious Ocular Inflammation', Ophthalmology, vol. 115, no. 10, pp. 1826-1832. https://doi.org/10.1016/j.ophtha.2008.04.026
Galor, Anat ; Jabs, Douglas A. ; Leder, Henry A. ; Kedhar, Sanjay R. ; Dunn, James P. ; Peters, George B. ; Thorne, Jennifer E. / Comparison of Antimetabolite Drugs as Corticosteroid-Sparing Therapy for Noninfectious Ocular Inflammation. In: Ophthalmology. 2008 ; Vol. 115, No. 10. pp. 1826-1832.
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abstract = "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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AU - Jabs, Douglas A.

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AU - Kedhar, Sanjay R.

AU - Dunn, James P.

AU - Peters, George B.

AU - Thorne, Jennifer E.

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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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