Cyclophosphamide for Ocular Inflammatory Diseases

Siddharth S. Pujari, John H. Kempen, Craig W. Newcomb, Sapna Gangaputra, Ebenezer Daniel, Eric Suhler, Jennifer E. Thorne, Douglas A. Jabs, Grace A. Levy-Clarke, Robert B. Nussenblatt, James (Jim) Rosenbaum, C. Stephen Foster

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

Purpose: To evaluate the outcomes of cyclophosphamide therapy for noninfectious ocular inflammation. Design: Retrospective cohort study. Participants: Two hundred fifteen patients with noninfectious ocular inflammation observed from initiation of cyclophosphamide. Methods: Patients initiating cyclophosphamide, without other immunosuppressive drugs (other than corticosteroids), were identified at 4 centers. Dose of cyclophosphamide, response to therapy, corticosteroid-sparing effects, frequency of discontinuation, and reasons for discontinuation were obtained by medical record review of every visit. Main Outcome Measures: Control of inflammation, corticosteroid-sparing effects, and discontinuation of therapy. Results: The 215 patients (381 involved eyes) meeting eligibility criteria carried diagnoses of uveitis (20.4%), scleritis (22.3%), ocular mucous membrane pemphigoid (45.6%), or other forms of ocular inflammation (11.6%). Overall, approximately 49.2% (95% confidence interval [CI], 41.7%-57.2%) gained sustained control of inflammation (for at least 28 days) within 6 months, and 76% (95% CI, 68.3%-83.7%) gained sustained control of inflammation within 12 months. Corticosteroid-sparing success (sustained control of inflammation while tapering prednisone to 10 mg or less among those not meeting success criteria initially) was gained by 30.0% and 61.2% by 6 and 12 months, respectively. Disease remission leading to discontinuation of cyclophosphamide occurred at the rate of 0.32/person-year (95% CI, 0.24-0.41), and the estimated proportion with remission at or before 2 years was 63.1% (95% CI, 51.5%-74.8%). Cyclophosphamide was discontinued by 33.5% of patients within 1 year because of side effects, usually of a reversible nature. Conclusions: The data suggest that cyclophosphamide is effective for most patients for controlling inflammation and allowing tapering of systemic corticosteroids to 10 mg prednisone or less, although 1 year of therapy may be needed to achieve these goals. Unlike with most other immunosuppressive drugs, disease remission was induced by treatment in most patients who were able to tolerate therapy. To titrate therapy properly and to minimize the risk of serious potential side effects, a systematic program of laboratory monitoring is required. Judicious use of cyclophosphamide seems to be beneficial for severe ocular inflammation cases where the potentially vision-saving benefits outweigh the substantial potential side effects of therapy, or when indicated for associated systemic inflammatory diseases. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

Original languageEnglish (US)
Pages (from-to)356-365
Number of pages10
JournalOphthalmology
Volume117
Issue number2
DOIs
StatePublished - Feb 2010

Fingerprint

Eye Diseases
Cyclophosphamide
Inflammation
Adrenal Cortex Hormones
Confidence Intervals
Disclosure
Therapeutics
Immunosuppressive Agents
Prednisone
Scleritis
Bullous Pemphigoid
Uveitis
Pharmaceutical Preparations
Medical Records
Mucous Membrane
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Pujari, S. S., Kempen, J. H., Newcomb, C. W., Gangaputra, S., Daniel, E., Suhler, E., ... Foster, C. S. (2010). Cyclophosphamide for Ocular Inflammatory Diseases. Ophthalmology, 117(2), 356-365. https://doi.org/10.1016/j.ophtha.2009.06.060

Cyclophosphamide for Ocular Inflammatory Diseases. / Pujari, Siddharth S.; Kempen, John H.; Newcomb, Craig W.; Gangaputra, Sapna; Daniel, Ebenezer; Suhler, Eric; Thorne, Jennifer E.; Jabs, Douglas A.; Levy-Clarke, Grace A.; Nussenblatt, Robert B.; Rosenbaum, James (Jim); Foster, C. Stephen.

In: Ophthalmology, Vol. 117, No. 2, 02.2010, p. 356-365.

Research output: Contribution to journalArticle

Pujari, SS, Kempen, JH, Newcomb, CW, Gangaputra, S, Daniel, E, Suhler, E, Thorne, JE, Jabs, DA, Levy-Clarke, GA, Nussenblatt, RB, Rosenbaum, JJ & Foster, CS 2010, 'Cyclophosphamide for Ocular Inflammatory Diseases', Ophthalmology, vol. 117, no. 2, pp. 356-365. https://doi.org/10.1016/j.ophtha.2009.06.060
Pujari SS, Kempen JH, Newcomb CW, Gangaputra S, Daniel E, Suhler E et al. Cyclophosphamide for Ocular Inflammatory Diseases. Ophthalmology. 2010 Feb;117(2):356-365. https://doi.org/10.1016/j.ophtha.2009.06.060
Pujari, Siddharth S. ; Kempen, John H. ; Newcomb, Craig W. ; Gangaputra, Sapna ; Daniel, Ebenezer ; Suhler, Eric ; Thorne, Jennifer E. ; Jabs, Douglas A. ; Levy-Clarke, Grace A. ; Nussenblatt, Robert B. ; Rosenbaum, James (Jim) ; Foster, C. Stephen. / Cyclophosphamide for Ocular Inflammatory Diseases. In: Ophthalmology. 2010 ; Vol. 117, No. 2. pp. 356-365.
@article{4e0cb38e4a764e7fbd7f58b0a9963d1d,
title = "Cyclophosphamide for Ocular Inflammatory Diseases",
abstract = "Purpose: To evaluate the outcomes of cyclophosphamide therapy for noninfectious ocular inflammation. Design: Retrospective cohort study. Participants: Two hundred fifteen patients with noninfectious ocular inflammation observed from initiation of cyclophosphamide. Methods: Patients initiating cyclophosphamide, without other immunosuppressive drugs (other than corticosteroids), were identified at 4 centers. Dose of cyclophosphamide, response to therapy, corticosteroid-sparing effects, frequency of discontinuation, and reasons for discontinuation were obtained by medical record review of every visit. Main Outcome Measures: Control of inflammation, corticosteroid-sparing effects, and discontinuation of therapy. Results: The 215 patients (381 involved eyes) meeting eligibility criteria carried diagnoses of uveitis (20.4{\%}), scleritis (22.3{\%}), ocular mucous membrane pemphigoid (45.6{\%}), or other forms of ocular inflammation (11.6{\%}). Overall, approximately 49.2{\%} (95{\%} confidence interval [CI], 41.7{\%}-57.2{\%}) gained sustained control of inflammation (for at least 28 days) within 6 months, and 76{\%} (95{\%} CI, 68.3{\%}-83.7{\%}) gained sustained control of inflammation within 12 months. Corticosteroid-sparing success (sustained control of inflammation while tapering prednisone to 10 mg or less among those not meeting success criteria initially) was gained by 30.0{\%} and 61.2{\%} by 6 and 12 months, respectively. Disease remission leading to discontinuation of cyclophosphamide occurred at the rate of 0.32/person-year (95{\%} CI, 0.24-0.41), and the estimated proportion with remission at or before 2 years was 63.1{\%} (95{\%} CI, 51.5{\%}-74.8{\%}). Cyclophosphamide was discontinued by 33.5{\%} of patients within 1 year because of side effects, usually of a reversible nature. Conclusions: The data suggest that cyclophosphamide is effective for most patients for controlling inflammation and allowing tapering of systemic corticosteroids to 10 mg prednisone or less, although 1 year of therapy may be needed to achieve these goals. Unlike with most other immunosuppressive drugs, disease remission was induced by treatment in most patients who were able to tolerate therapy. To titrate therapy properly and to minimize the risk of serious potential side effects, a systematic program of laboratory monitoring is required. Judicious use of cyclophosphamide seems to be beneficial for severe ocular inflammation cases where the potentially vision-saving benefits outweigh the substantial potential side effects of therapy, or when indicated for associated systemic inflammatory diseases. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.",
author = "Pujari, {Siddharth S.} and Kempen, {John H.} and Newcomb, {Craig W.} and Sapna Gangaputra and Ebenezer Daniel and Eric Suhler and Thorne, {Jennifer E.} and Jabs, {Douglas A.} and Levy-Clarke, {Grace A.} and Nussenblatt, {Robert B.} and Rosenbaum, {James (Jim)} and Foster, {C. Stephen}",
year = "2010",
month = "2",
doi = "10.1016/j.ophtha.2009.06.060",
language = "English (US)",
volume = "117",
pages = "356--365",
journal = "Ophthalmology",
issn = "0161-6420",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Cyclophosphamide for Ocular Inflammatory Diseases

AU - Pujari, Siddharth S.

AU - Kempen, John H.

AU - Newcomb, Craig W.

AU - Gangaputra, Sapna

AU - Daniel, Ebenezer

AU - Suhler, Eric

AU - Thorne, Jennifer E.

AU - Jabs, Douglas A.

AU - Levy-Clarke, Grace A.

AU - Nussenblatt, Robert B.

AU - Rosenbaum, James (Jim)

AU - Foster, C. Stephen

PY - 2010/2

Y1 - 2010/2

N2 - Purpose: To evaluate the outcomes of cyclophosphamide therapy for noninfectious ocular inflammation. Design: Retrospective cohort study. Participants: Two hundred fifteen patients with noninfectious ocular inflammation observed from initiation of cyclophosphamide. Methods: Patients initiating cyclophosphamide, without other immunosuppressive drugs (other than corticosteroids), were identified at 4 centers. Dose of cyclophosphamide, response to therapy, corticosteroid-sparing effects, frequency of discontinuation, and reasons for discontinuation were obtained by medical record review of every visit. Main Outcome Measures: Control of inflammation, corticosteroid-sparing effects, and discontinuation of therapy. Results: The 215 patients (381 involved eyes) meeting eligibility criteria carried diagnoses of uveitis (20.4%), scleritis (22.3%), ocular mucous membrane pemphigoid (45.6%), or other forms of ocular inflammation (11.6%). Overall, approximately 49.2% (95% confidence interval [CI], 41.7%-57.2%) gained sustained control of inflammation (for at least 28 days) within 6 months, and 76% (95% CI, 68.3%-83.7%) gained sustained control of inflammation within 12 months. Corticosteroid-sparing success (sustained control of inflammation while tapering prednisone to 10 mg or less among those not meeting success criteria initially) was gained by 30.0% and 61.2% by 6 and 12 months, respectively. Disease remission leading to discontinuation of cyclophosphamide occurred at the rate of 0.32/person-year (95% CI, 0.24-0.41), and the estimated proportion with remission at or before 2 years was 63.1% (95% CI, 51.5%-74.8%). Cyclophosphamide was discontinued by 33.5% of patients within 1 year because of side effects, usually of a reversible nature. Conclusions: The data suggest that cyclophosphamide is effective for most patients for controlling inflammation and allowing tapering of systemic corticosteroids to 10 mg prednisone or less, although 1 year of therapy may be needed to achieve these goals. Unlike with most other immunosuppressive drugs, disease remission was induced by treatment in most patients who were able to tolerate therapy. To titrate therapy properly and to minimize the risk of serious potential side effects, a systematic program of laboratory monitoring is required. Judicious use of cyclophosphamide seems to be beneficial for severe ocular inflammation cases where the potentially vision-saving benefits outweigh the substantial potential side effects of therapy, or when indicated for associated systemic inflammatory diseases. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

AB - Purpose: To evaluate the outcomes of cyclophosphamide therapy for noninfectious ocular inflammation. Design: Retrospective cohort study. Participants: Two hundred fifteen patients with noninfectious ocular inflammation observed from initiation of cyclophosphamide. Methods: Patients initiating cyclophosphamide, without other immunosuppressive drugs (other than corticosteroids), were identified at 4 centers. Dose of cyclophosphamide, response to therapy, corticosteroid-sparing effects, frequency of discontinuation, and reasons for discontinuation were obtained by medical record review of every visit. Main Outcome Measures: Control of inflammation, corticosteroid-sparing effects, and discontinuation of therapy. Results: The 215 patients (381 involved eyes) meeting eligibility criteria carried diagnoses of uveitis (20.4%), scleritis (22.3%), ocular mucous membrane pemphigoid (45.6%), or other forms of ocular inflammation (11.6%). Overall, approximately 49.2% (95% confidence interval [CI], 41.7%-57.2%) gained sustained control of inflammation (for at least 28 days) within 6 months, and 76% (95% CI, 68.3%-83.7%) gained sustained control of inflammation within 12 months. Corticosteroid-sparing success (sustained control of inflammation while tapering prednisone to 10 mg or less among those not meeting success criteria initially) was gained by 30.0% and 61.2% by 6 and 12 months, respectively. Disease remission leading to discontinuation of cyclophosphamide occurred at the rate of 0.32/person-year (95% CI, 0.24-0.41), and the estimated proportion with remission at or before 2 years was 63.1% (95% CI, 51.5%-74.8%). Cyclophosphamide was discontinued by 33.5% of patients within 1 year because of side effects, usually of a reversible nature. Conclusions: The data suggest that cyclophosphamide is effective for most patients for controlling inflammation and allowing tapering of systemic corticosteroids to 10 mg prednisone or less, although 1 year of therapy may be needed to achieve these goals. Unlike with most other immunosuppressive drugs, disease remission was induced by treatment in most patients who were able to tolerate therapy. To titrate therapy properly and to minimize the risk of serious potential side effects, a systematic program of laboratory monitoring is required. Judicious use of cyclophosphamide seems to be beneficial for severe ocular inflammation cases where the potentially vision-saving benefits outweigh the substantial potential side effects of therapy, or when indicated for associated systemic inflammatory diseases. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

UR - http://www.scopus.com/inward/record.url?scp=75149148986&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=75149148986&partnerID=8YFLogxK

U2 - 10.1016/j.ophtha.2009.06.060

DO - 10.1016/j.ophtha.2009.06.060

M3 - Article

C2 - 19969366

AN - SCOPUS:75149148986

VL - 117

SP - 356

EP - 365

JO - Ophthalmology

JF - Ophthalmology

SN - 0161-6420

IS - 2

ER -