[Role of Azathioprine in steroid resistant non infectious ocular inflammatory diseases].
BACKGROUND
Topical and systemic steroids are the first line of treatment of non infectious inflammatory ocular disease. Immunosuppresants are reserved as a second line treatment.


OBJECTIVE
To evaluate the role of Azathioprine (AZA) as a coadyuvant immunosuppressive treatment for non infectious ocular inflammatory diseases (OIDs) resistant to systemic steroid therapy in a retrospective, noncomparative interventional case series.


METHODS
Patients using oral Prednisone due to an active or recurrent OID, without clinical response, and not receiving any other immunosuppressive treatment were studied. A standard protocol of oral Prednisone (0.5 mg/kg/ day) and oral AZA (2-3 mg/kg/day) during one year was used. Ocular and systemic monthly evaluations were done including relapse rate, steroid dosage, inflammatory score and visual acuity.


RESULTS
Thirty patients (10 male) aged 18-75 years (mean 44 years) were studied. Three had bilateral anterior uveitis, one had pars planitis, four had diffuse uveitis, eight Vogt-Koyanahi-Harada syndrome, three Behget's disease, three necrotizing scleritis and eight had retinochoroidopathy A complete initial response was observed in 26 patients (87%). The time of response was between 1 to 6 months (mean 2.65 months). Seventeen percent of these had a relapse 6 to 12 months after AZA was started. In 61 %, visual acuity improved. The ocular inflammatory score decreased in 86.5%. Eleven patients had mild controlled side effects that did not require discontinuation of AZA.


CONCLUSIONS
Combined systemic steroid and oral AZA therapy is safe and effective in controlling steroid resistant non infectious inflammatory ocular diseases.
Cuchacovich
Miguel
M
Sección de Reumatología, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Santiago, Chile. mcuchacovich@redclinicauchile.cl
Pacheco
Patricio
P
Díaz
Gonzalo
G
Rojas
Basilio
B
Stoppel
Juan
J
Merino
Guillermo
G
Verdaguer
Juan Ignacio
JI
Verdaguer
Juan
J
Villarroel
Francisco
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000009:adverse effects / Q000627:therapeutic use*; D015862:Choroid Diseases / Q000188:drug therapy; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012164:Retinal Diseases / Q000188:drug therapy; D012189:Retrospective Studies; D015423:Scleritis / Q000188:drug therapy; D013256:Steroids / Q000627:therapeutic use; D014605:Uveitis / Q000188:drug therapy*; D014607:Uveomeningoencephalitic Syndrome / Q000188:drug therapy
D007166:Immunosuppressive Agents; D013256:Steroids; D001379:Azathioprine