Elsevier

Ophthalmology

Volume 115, Issue 10, October 2008, Pages 1826-1832
Ophthalmology

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

Presented in poster form at the American Academy of Ophthalmology meeting, New Orleans, Louisiana, 2007.
https://doi.org/10.1016/j.ophtha.2008.04.026Get rights and content

Purpose

To compare the relative effectiveness and side effect profiles of antimetabolite drugs in the treatment of noninfectious ocular inflammation.

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.

Section snippets

Study Population

All patients with noninfectious inflammatory eye diseases seen in the Division of Ocular Immunology at the Wilmer Eye Institute from July of 1984 to December of 2006 and treated with an antimetabolite agent for ocular inflammation were considered for this study (N = 321). Patients were identified from a database maintained in the division for purposes of laboratory monitoring while patients are receiving immunosuppressive drug therapy. Patients were excluded from the analyses if (1) they had <3

Study Population at Presentation

The demographic and clinical characteristics of the study population are summarized in Table 2. Ninety patients with inflammatory eye disease were treated with methotrexate, 38 patients were treated with azathioprine, and 129 patients were treated with mycophenolate mofetil as their first exposure to antimetabolite therapy in the Division of Ocular Immunology (Table 2). The median age at the start of treatment with an antimetabolite was different among the groups; patients receiving

Discussion

The 3 most commonly used antimetabolite agents in treating ocular inflammation are methotrexate, azathioprine, and mycophenolate. Several centers have reviewed retrospectively their experience with single agents in this family;2, 3, 5, 6, 7, 8, 9, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 none have compared directly the effectiveness and side effect profiles of these therapies. To do so, we conducted a retrospective review of all patients treated with one of these agents for ocular inflammation

References (26)

  • E.C. Kim et al.

    Immunomodulatory therapy for the treatment of ocular inflammatory disease: evidence-based medicine recommendations for use

    Int Ophthalmol Clin

    (2006)
  • I. Foeldvari et al.

    Methotrexate is an effective treatment for chronic uveitis associated with juvenile idiopathic arthritis

    J Rheumatol

    (2005)
  • Standardization of uveitis nomenclature for reporting clinical data: results of the First International Workshop

    Am J Ophthalmol

    (2005)
  • Cited by (0)

    Manuscript no. 2007-1564.

    Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

    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.

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