Systemic Immunomodulatory Therapy in the Uveitis Clinic: 10-year profile
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Yes
Purpose
Immunomodulatory therapy (IMT) in non-infectious uveitis aims to achieve durable remission. Data on sustained remission after withdrawn of IMT are limited. Our primary purpose was to characterize the IMT profile in patients with idiopathic uveitis (IU) regarding duration and discontinuation of IMT and pattern of disease relapse.
Methods
Retrospective review of patients with idiopathic uveitis under IMT evaluated in the past
Results
A total of 111 patients with idiopathic uveitis under IMT were included, divided into 5 anatomic groups: anterior uveitis (30;27%), intermediate uveitis (14;12.6%), posterior uveitis (31;27.9%), panuveitis (23;20.7%) and scleritis (13;11.7%). The mean follow-up time was 94.9±52.6 months [12-264]. 84 patients (76.4%) presented bilateral involvement. Methotrexate was the most widely used IMT (n=59,53.2%) followed by cyclosporine (n=33,29.7%), azathioprine (n=10,9%) and adalimumab (n=9,8.1%). The median duration of treatment was 36 months (IQR 24-60), with 67 patients (60.4%) under IMT for at least 3 years. Before treatment, patients presented a mean of 2.1±1.4 flare-ups/year, which significantly decreased to a mean of 0.6±0.7 relapses/year after IMT (p<0.001) in all anatomic groups. From the 53 patients (47.7%) who stopped IMT, 14 (26.4%) relapsed. 91.3% of the patients treated for >3 years and 100% of the patients treated for >4 years did not relapse. The group without uveitis recurrence was under IMT for a significantly longer period before stopping (51.2±35 vs 26.4±12, p<0.001), comparing to the patients who relapsed.
Conclusion
The decision to stop IMT based on a 3-year remission period appears to be a safe approach preventing recurrent sight threatening inflammation.
Conflict of interest
No
1
Last name
FERREIRA
Initials of first name(s)
AM
Department
Ophthalmology
City
Porto
Country
Portugal
2
Last name
Silva
Initials of first name(s)
M
Department
Ophthalmology
City
Porto
Country
Portugal
3
Last name
Pedrosa
Initials of first name(s)
C
Department
Ophthalmology
City
Porto
Country
Portugal
4
Last name
Oliveira-Ferreira
Initials of first name(s)
C
Department
Ophthalmology
City
Porto
Country
Portugal
5
Last name
Torres-Costa
Initials of first name(s)
S
Department
Ophthalmology
City
Porto
Country
Portugal
6
Last name
Torrão
Initials of first name(s)
L
Department
Ophthalmology
City
Porto
Country
Portugal
7
Last name
Figueira
Initials of first name(s)
L
Department
Ophthalmology
City
Porto
Country
Portugal
8
Last name
Rodrigues-Araújo
Initials of first name(s)
J
Department
Ophthalmology
City
Porto
Country
Portugal
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