TY - JOUR
T1 - Azathioprine for Ocular Inflammatory Diseases
AU - Pasadhika, Sirichai
AU - Kempen, John H.
AU - Newcomb, Craig W.
AU - Liesegang, Teresa L.
AU - Pujari, Siddharth S.
AU - Rosenbaum, James T.
AU - Thorne, Jennifer E.
AU - Foster, C. Stephen
AU - Jabs, Douglas A.
AU - Levy-Clarke, Grace A.
AU - Nussenblatt, Robert B.
AU - Suhler, Eric B.
N1 - Funding Information:
This study was supported by the National Eye Institute, Bethesda, Maryland, Grant No. EY-014943 (Dr Kempen); the Paul and Evanina Mackall Foundation, New York, New York; and Research to Prevent Blindness Inc, New York, New York. Dr Kempen is a Research to Prevent Blindness James S. Adams Special Scholar Award recipient. Drs Jabs and Rosenbaum are recipients of Research to Prevent Blindness Senior Scientific Investigator Awards. Dr Levy-Clarke previously was supported by and Dr Nussenblatt is supported by intramural funds of the National Eye Institute, Bethesda, Maryland. Dr Suhler also received support from the Veterans' Administration. Dr Foster has served as a consultant to Allergan, Bausch & Lomb, and Sirion; owns equity or stock options in Eyegate; and has received speaking fees from Alcon, Allergan, Inspire, Ista, Bausch & Lomb, and Centocor. Dr Jabs has served as a consultant to Abbott, Genzyme Corporation, Novartis, Allergan, the Emmes Corporation (DSMC member), and the Johns Hopkins University Dana Center for Preventive Ophthalmology. Dr Kempen has served as a consultant to Lux Biosciences and has participated in clinical trials funded by Allergan and Eyegate. Dr Rosenbaum has served as a consultant to Abbott, Amgen, Allergan, Lux Biosciences, and Novartis; holds equity ownership/stock options in Amgen; and has received research support from Genentech, Lux Biosciences, and Abbott. Dr Suhler has received research support from Eyegate, Genentech, Lux Biosciences, and Abbott. Involved in design of study (S.P., J.H.K., C.W.N.); conduct of study (S.P., J.H.K., E.B.S.); collection of data (S.P., J.H.K., C.W.N., T.L.L., S.S.P., J.T.R., J.E.T., C.S.F., D.A.J., G.A.L.-C., R.B.N., E.B.S.); management (S.P., J.H.K., J.T.R., J.E.T., C.S.F., D.A.J., G.A.L.-C., R.B.N., E.B.S.), analysis, and interpretation of data (S.P., J.H.K., C.W.N., E.B.S.); and preparation (S.P., J.H.K., E.B.S.), review, and approval of the manuscript (S.P., J.H.K., C.W.N., T.L.L., S.S.P., J.T.R., J.E.T., C.S.F., D.A.J., G.A.L.-C., R.B.N., E.B.S.). The protocol was approved by Institutional Review Boards of all participating institutions and was conducted in accordance with the principles of the Declaration of Helsinki and the Health Insurance Portability and Accountability Act.
PY - 2009/10
Y1 - 2009/10
N2 - Purpose: To evaluate treatment outcomes of azathioprine for noninfectious ocular inflammatory diseases. Design: Retrospective cohort study. Methods: Medical records of 145 patients starting azathioprine as a sole noncorticosteroid immunosuppressant at 4 tertiary uveitis services were reviewed. Main outcome measures included control of ocular inflammation, sustained control after tapering prednisone to ≤ 10 mg/day, and discontinuation of treatment because of side effects. Results: Among 145 patients (255 eyes) treated with azathioprine, 63% had uveitis, 23% had mucous membrane pemphigoid, 11% had scleritis, and 3% had other inflammatory diseases. By Kaplan-Meier analysis, 62% (95% confidence interval [CI], 50% to 74%) of patients with active disease initially gained complete inactivity of inflammation sustained over at least 28 days within 1 year of therapy, and 47% (95% CI, 37% to 58%) tapered systemic corticosteroids to ≤ 10 mg daily while maintaining control of inflammation within 1 year of therapy. Treatment success was most common for intermediate uveitis (90% with sustained inactivity within 1 year; 95% CI, 64% to 99%). Over the median follow-up of 230 days (interquartile range, 62 to 679 days), azathioprine was discontinued at a rate of 0.45 per person-years (/PY): 0.16/PY because of side effects, 0.10/PY because of ineffectiveness, 0.09/PY because of disease remission, and 0.10/PY because of unspecified causes. Conclusions: Azathioprine was moderately effective as a single corticosteroid-sparing immunosuppressive agent in terms of control of inflammation and corticosteroid-sparing benefits, but required several months to achieve treatment goals; it seems especially useful for patients with intermediate uveitis. Treatment-limiting side effects occurred in approximately one-fourth of patients within 1 year, but typically were reversible.
AB - Purpose: To evaluate treatment outcomes of azathioprine for noninfectious ocular inflammatory diseases. Design: Retrospective cohort study. Methods: Medical records of 145 patients starting azathioprine as a sole noncorticosteroid immunosuppressant at 4 tertiary uveitis services were reviewed. Main outcome measures included control of ocular inflammation, sustained control after tapering prednisone to ≤ 10 mg/day, and discontinuation of treatment because of side effects. Results: Among 145 patients (255 eyes) treated with azathioprine, 63% had uveitis, 23% had mucous membrane pemphigoid, 11% had scleritis, and 3% had other inflammatory diseases. By Kaplan-Meier analysis, 62% (95% confidence interval [CI], 50% to 74%) of patients with active disease initially gained complete inactivity of inflammation sustained over at least 28 days within 1 year of therapy, and 47% (95% CI, 37% to 58%) tapered systemic corticosteroids to ≤ 10 mg daily while maintaining control of inflammation within 1 year of therapy. Treatment success was most common for intermediate uveitis (90% with sustained inactivity within 1 year; 95% CI, 64% to 99%). Over the median follow-up of 230 days (interquartile range, 62 to 679 days), azathioprine was discontinued at a rate of 0.45 per person-years (/PY): 0.16/PY because of side effects, 0.10/PY because of ineffectiveness, 0.09/PY because of disease remission, and 0.10/PY because of unspecified causes. Conclusions: Azathioprine was moderately effective as a single corticosteroid-sparing immunosuppressive agent in terms of control of inflammation and corticosteroid-sparing benefits, but required several months to achieve treatment goals; it seems especially useful for patients with intermediate uveitis. Treatment-limiting side effects occurred in approximately one-fourth of patients within 1 year, but typically were reversible.
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U2 - 10.1016/j.ajo.2009.05.008
DO - 10.1016/j.ajo.2009.05.008
M3 - Article
C2 - 19570522
AN - SCOPUS:70349275216
SN - 0002-9394
VL - 148
SP - 500-509.e2
JO - American journal of ophthalmology
JF - American journal of ophthalmology
IS - 4
ER -