Factors Predictive of Remission of Chronic Anterior Uveitis

Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study Research Group

Research output: Contribution to journalArticle

Abstract

Purpose: To estimate the incidence of medication-free remission of chronic anterior uveitis and identify predictors thereof. Design: Retrospective cohort study. Participants: Patients diagnosed with anterior uveitis of longer than 3 months’ duration followed up at United States tertiary uveitis care facilities. Methods: Estimation of remission incidence and identification of associated predictors used survival analysis. Main Outcome Measures: Incidence of medication-free remission. For the primary analysis, remission was defined as inactive uveitis while off treatment at all visits spanning an interval of at least 90 days or—for patients who did not return for follow-up after 90 days—remaining inactive without receiving suppressive medications at all of the last visits. Association of factors potentially predictive of medication-free remission was also studied. Results: Two thousand seven hundred ninety-five eyes of 1634 patients with chronic anterior uveitis were followed up over 7936 eye-years (4676 person-years). The cumulative medication-free, person-year remission incidence within 5 years was 32.7% (95% confidence interval [CI], 30.4%–35.2%). Baseline clinical factors predictive of reduced remission incidence included longer duration of uveitis at presentation (for 2 to 5 years vs. less than 6 months: adjusted hazard ratio [aHR], 0.61; 95% CI, 0.44–0.83), bilateral uveitis (aHR, 0.75; 95% CI, 0.59–0.96), prior cataract surgery (aHR, 0.70; 95% CI 0.56–0.88), and glaucoma surgery (aHR, 0.63; 95% CI, 0.45–0.90). Two time-updated characteristics were also predictive of reduced remission incidence: keratic precipitates (aHR, 0.36; 95% CI, 0.21–0.60) and synechiae (aHR, 0.62; 95% CI, 0.41–0.93). Systemic diagnosis with juvenile idiopathic arthritis and spondyloarthropathy were also associated with reduced remission incidence. Older age at presentation was associated with higher incidence of remission (for age ≥40 years vs. <40 years: aHR, 1.29; 95% CI, 1.02–1.63). Conclusions: Approximately one third of patients with chronic anterior uveitis remit within 5 years. Longer duration of uveitis, younger age, bilateral uveitis, prior cataract surgery, glaucoma surgery, presence of keratic precipitates and synechiae, and systemic diagnoses of juvenile idiopathic arthritis and spondyloarthropathy predict reduced remission incidence; patients with these factors should be managed taking into account the higher probability of a longer disease course.

Original languageEnglish (US)
JournalOphthalmology
DOIs
StateAccepted/In press - Jan 1 2020

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Anterior Uveitis
Uveitis
Confidence Intervals
Incidence
Spondylarthropathies
Juvenile Arthritis
Glaucoma
Cataract
Tertiary Healthcare
Survival Analysis
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

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Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study Research Group (Accepted/In press). Factors Predictive of Remission of Chronic Anterior Uveitis. Ophthalmology. https://doi.org/10.1016/j.ophtha.2019.11.020

Factors Predictive of Remission of Chronic Anterior Uveitis. / Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study Research Group.

In: Ophthalmology, 01.01.2020.

Research output: Contribution to journalArticle

Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study Research Group 2020, 'Factors Predictive of Remission of Chronic Anterior Uveitis', Ophthalmology. https://doi.org/10.1016/j.ophtha.2019.11.020
Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study Research Group. Factors Predictive of Remission of Chronic Anterior Uveitis. Ophthalmology. 2020 Jan 1. https://doi.org/10.1016/j.ophtha.2019.11.020
Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study Research Group. / Factors Predictive of Remission of Chronic Anterior Uveitis. In: Ophthalmology. 2020.
@article{db03682b39b04b9190f46bb70caa0f38,
title = "Factors Predictive of Remission of Chronic Anterior Uveitis",
abstract = "Purpose: To estimate the incidence of medication-free remission of chronic anterior uveitis and identify predictors thereof. Design: Retrospective cohort study. Participants: Patients diagnosed with anterior uveitis of longer than 3 months’ duration followed up at United States tertiary uveitis care facilities. Methods: Estimation of remission incidence and identification of associated predictors used survival analysis. Main Outcome Measures: Incidence of medication-free remission. For the primary analysis, remission was defined as inactive uveitis while off treatment at all visits spanning an interval of at least 90 days or—for patients who did not return for follow-up after 90 days—remaining inactive without receiving suppressive medications at all of the last visits. Association of factors potentially predictive of medication-free remission was also studied. Results: Two thousand seven hundred ninety-five eyes of 1634 patients with chronic anterior uveitis were followed up over 7936 eye-years (4676 person-years). The cumulative medication-free, person-year remission incidence within 5 years was 32.7{\%} (95{\%} confidence interval [CI], 30.4{\%}–35.2{\%}). Baseline clinical factors predictive of reduced remission incidence included longer duration of uveitis at presentation (for 2 to 5 years vs. less than 6 months: adjusted hazard ratio [aHR], 0.61; 95{\%} CI, 0.44–0.83), bilateral uveitis (aHR, 0.75; 95{\%} CI, 0.59–0.96), prior cataract surgery (aHR, 0.70; 95{\%} CI 0.56–0.88), and glaucoma surgery (aHR, 0.63; 95{\%} CI, 0.45–0.90). Two time-updated characteristics were also predictive of reduced remission incidence: keratic precipitates (aHR, 0.36; 95{\%} CI, 0.21–0.60) and synechiae (aHR, 0.62; 95{\%} CI, 0.41–0.93). Systemic diagnosis with juvenile idiopathic arthritis and spondyloarthropathy were also associated with reduced remission incidence. Older age at presentation was associated with higher incidence of remission (for age ≥40 years vs. <40 years: aHR, 1.29; 95{\%} CI, 1.02–1.63). Conclusions: Approximately one third of patients with chronic anterior uveitis remit within 5 years. Longer duration of uveitis, younger age, bilateral uveitis, prior cataract surgery, glaucoma surgery, presence of keratic precipitates and synechiae, and systemic diagnoses of juvenile idiopathic arthritis and spondyloarthropathy predict reduced remission incidence; patients with these factors should be managed taking into account the higher probability of a longer disease course.",
author = "{Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study Research Group} and Lucia Sobrin and Maxwell Pistilli and Kurt Dreger and Srishti Kothari and Naira Khachatryan and Pichaporn Artornsombudh and Pujari, {Siddharth S.} and Foster, {C. Stephen} and Jabs, {Douglas A.} and Nussenblatt, {Robert B.} and Rosenbaum, {James T.} and Levy-Clarke, {Grace A.} and Sen, {H. Nida} and Suhler, {Eric B.} and Thorne, {Jennifer E.} and Bhatt, {Nirali P.} and Kempen, {John H.}",
year = "2020",
month = "1",
day = "1",
doi = "10.1016/j.ophtha.2019.11.020",
language = "English (US)",
journal = "Ophthalmology",
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TY - JOUR

T1 - Factors Predictive of Remission of Chronic Anterior Uveitis

AU - Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study Research Group

AU - Sobrin, Lucia

AU - Pistilli, Maxwell

AU - Dreger, Kurt

AU - Kothari, Srishti

AU - Khachatryan, Naira

AU - Artornsombudh, Pichaporn

AU - Pujari, Siddharth S.

AU - Foster, C. Stephen

AU - Jabs, Douglas A.

AU - Nussenblatt, Robert B.

AU - Rosenbaum, James T.

AU - Levy-Clarke, Grace A.

AU - Sen, H. Nida

AU - Suhler, Eric B.

AU - Thorne, Jennifer E.

AU - Bhatt, Nirali P.

AU - Kempen, John H.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Purpose: To estimate the incidence of medication-free remission of chronic anterior uveitis and identify predictors thereof. Design: Retrospective cohort study. Participants: Patients diagnosed with anterior uveitis of longer than 3 months’ duration followed up at United States tertiary uveitis care facilities. Methods: Estimation of remission incidence and identification of associated predictors used survival analysis. Main Outcome Measures: Incidence of medication-free remission. For the primary analysis, remission was defined as inactive uveitis while off treatment at all visits spanning an interval of at least 90 days or—for patients who did not return for follow-up after 90 days—remaining inactive without receiving suppressive medications at all of the last visits. Association of factors potentially predictive of medication-free remission was also studied. Results: Two thousand seven hundred ninety-five eyes of 1634 patients with chronic anterior uveitis were followed up over 7936 eye-years (4676 person-years). The cumulative medication-free, person-year remission incidence within 5 years was 32.7% (95% confidence interval [CI], 30.4%–35.2%). Baseline clinical factors predictive of reduced remission incidence included longer duration of uveitis at presentation (for 2 to 5 years vs. less than 6 months: adjusted hazard ratio [aHR], 0.61; 95% CI, 0.44–0.83), bilateral uveitis (aHR, 0.75; 95% CI, 0.59–0.96), prior cataract surgery (aHR, 0.70; 95% CI 0.56–0.88), and glaucoma surgery (aHR, 0.63; 95% CI, 0.45–0.90). Two time-updated characteristics were also predictive of reduced remission incidence: keratic precipitates (aHR, 0.36; 95% CI, 0.21–0.60) and synechiae (aHR, 0.62; 95% CI, 0.41–0.93). Systemic diagnosis with juvenile idiopathic arthritis and spondyloarthropathy were also associated with reduced remission incidence. Older age at presentation was associated with higher incidence of remission (for age ≥40 years vs. <40 years: aHR, 1.29; 95% CI, 1.02–1.63). Conclusions: Approximately one third of patients with chronic anterior uveitis remit within 5 years. Longer duration of uveitis, younger age, bilateral uveitis, prior cataract surgery, glaucoma surgery, presence of keratic precipitates and synechiae, and systemic diagnoses of juvenile idiopathic arthritis and spondyloarthropathy predict reduced remission incidence; patients with these factors should be managed taking into account the higher probability of a longer disease course.

AB - Purpose: To estimate the incidence of medication-free remission of chronic anterior uveitis and identify predictors thereof. Design: Retrospective cohort study. Participants: Patients diagnosed with anterior uveitis of longer than 3 months’ duration followed up at United States tertiary uveitis care facilities. Methods: Estimation of remission incidence and identification of associated predictors used survival analysis. Main Outcome Measures: Incidence of medication-free remission. For the primary analysis, remission was defined as inactive uveitis while off treatment at all visits spanning an interval of at least 90 days or—for patients who did not return for follow-up after 90 days—remaining inactive without receiving suppressive medications at all of the last visits. Association of factors potentially predictive of medication-free remission was also studied. Results: Two thousand seven hundred ninety-five eyes of 1634 patients with chronic anterior uveitis were followed up over 7936 eye-years (4676 person-years). The cumulative medication-free, person-year remission incidence within 5 years was 32.7% (95% confidence interval [CI], 30.4%–35.2%). Baseline clinical factors predictive of reduced remission incidence included longer duration of uveitis at presentation (for 2 to 5 years vs. less than 6 months: adjusted hazard ratio [aHR], 0.61; 95% CI, 0.44–0.83), bilateral uveitis (aHR, 0.75; 95% CI, 0.59–0.96), prior cataract surgery (aHR, 0.70; 95% CI 0.56–0.88), and glaucoma surgery (aHR, 0.63; 95% CI, 0.45–0.90). Two time-updated characteristics were also predictive of reduced remission incidence: keratic precipitates (aHR, 0.36; 95% CI, 0.21–0.60) and synechiae (aHR, 0.62; 95% CI, 0.41–0.93). Systemic diagnosis with juvenile idiopathic arthritis and spondyloarthropathy were also associated with reduced remission incidence. Older age at presentation was associated with higher incidence of remission (for age ≥40 years vs. <40 years: aHR, 1.29; 95% CI, 1.02–1.63). Conclusions: Approximately one third of patients with chronic anterior uveitis remit within 5 years. Longer duration of uveitis, younger age, bilateral uveitis, prior cataract surgery, glaucoma surgery, presence of keratic precipitates and synechiae, and systemic diagnoses of juvenile idiopathic arthritis and spondyloarthropathy predict reduced remission incidence; patients with these factors should be managed taking into account the higher probability of a longer disease course.

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