Outcomes of changing immunosuppressive therapy after treatment failure in patients with noninfectious uveitis.

Abstract

PURPOSE:

To evaluate the outcomes of changing immunosuppressive therapy for noninfectious uveitis after failure.

DESIGN:

Retrospective cohort study.

PARTICIPANTS:

Patients with noninfectious uveitis managed at 2 tertiary uveitis clinics in the United Kingdom and Australia.

METHODS:

Participants with a history of using immunosuppressive therapy were identified in clinics, and notes were reviewed by doctors trained in uveitis therapy. Each treatment episode/course (starting or changing a therapy) was identified, and demographic details, clinical characteristics, drug used (second-line immunosuppressive agent [ISA] or biologicals), and drug doses were obtained.

MAIN OUTCOME MEASURES:

For each treatment episode, the reasons for changing therapy, corticosteroid-sparing effects, and control of inflammation were determined.

RESULTS:

A total of 147 patients were identified who underwent 309 different treatment episodes. Fifty-five percent of patients eventually required a change in treatment after their first treatment episode/course. Forty-five episodes involved switching from one ISA to another, with 50% to 100% of these patients achieving "success" (prednisolone ≤10 mg and sustained control) with the new ISA. A combination of ISAs were used in 53 episodes, with "success" being achieved in 50% to 71% of these patients. Biological agents were used in 45 episodes, the most common one being infliximab, which achieved success in 80% of patients.

CONCLUSIONS:

Our data suggest that control of inflammation can be achieved after switching or combining ISAs.

• Authors: Lavnish Joshi, Lazha Talat, Satish Yaganti, Sartaj Sandhu, Simon R J Taylor, Denis Wakefield, Peter McCluskey, Susan Lightman
• Journal: Ophthalmology (Ophthalmology) Vol. 121 Issue 5 Pg. 1119-24 (May 2014) ISSN: 1549-4713 [Electronic] United States
• PMID: 24433970 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Immunosuppressive Agents
• Cyclosporine
• Prednisolone
• Mycophenolic Acid
• Azathioprine
• Methotrexate

Topics

• Adolescent
• Adult
• Aged
• Azathioprine (therapeutic use)
• Child
• Child, Preschool
• Cohort Studies
• Cyclosporine (therapeutic use)
• Drug Substitution
• Female
• Humans
• Immunosuppressive Agents (therapeutic use)
• Male
• Methotrexate (therapeutic use)
• Middle Aged
• Mycophenolic Acid (analogs & derivatives, therapeutic use)
• Prednisolone (therapeutic use)
• Retrospective Studies
• Treatment Failure
• Treatment Outcome
• Uveitis (drug therapy, physiopathology)
• Visual Acuity (physiology)
• Young Adult