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.
Received 7 December 2007; received in revised form 27 March 2008; accepted 18 April 2008. published online 25 June 2008.
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.
Available online: June 25, 2008.
1Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, Maryland
2Department of Medicine, the Johns Hopkins University School of Medicine, Baltimore, Maryland
3Department of Epidemiology, Center for Clinical Trials, the Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
4Department of Ophthalmology, Mount Sinai School of Medicine, New York, New York
5Department of Ophthalmology, New York Eye and Ear Infirmary, New York, New York
Correspondence: Jennifer E. Thorne, MD, PhD, Wilmer Eye Institute, 550 North Broadway, Suite 700, Baltimore, MD 21205
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.
ABSTRACT