title: Comparison of antimetabolite drugs as corticosteroid-sparing therapy for noninfectious ocular inflammation.
abstract: OBJECTIVE
  To compare the relative effectiveness and side effect profiles of antimetabolite drugs in the treatment of noninfectious ocular inflammation.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A total of 257 patients with inflammatory eye disease seen in a single-center, academic practice and treated with an antimetabolite as a first-line immunosuppressive agent from 1984 to 2006.
  
  
  METHODS
  Data recorded included demographics, antimetabolite and prednisone doses, use of other immunosuppressive drugs, response to therapy, and side effects associated with drug use.
  
  
  METHODS
  Ability to control ocular inflammation and to taper prednisone to <or=10 mg daily ("treatment success"); incidence of treatment-related side effects.
  
  
  RESULTS
  Ninety patients with inflammatory eye disease were treated with methotrexate, 38 patients were treated with azathioprine, and 129 patients were treated with mycophenolate. Uveitis accounted for the majority of the diagnoses (67%, 66%, and 68% for methotrexate, azathioprine, and mycophenolate, respectively), followed by scleritis (23%, 18%, 17% for methotrexate, azathioprine, and mycophenolate, respectively). The median time to treatment success was 4.0, 4.8, and 6.5 months for the mycophenolate, azathioprine, and methotrexate treatment groups, respectively (P = 0.02, log-rank test). The incidence of side effects was higher in the azathioprine group (0.29/person-year [PY]) compared with patients treated with methotrexate (0.14/PY) and mycophenolate (0.18/PY). More patients discontinued the drug because of side effects in the azathioprine group (0.24/PY vs 0.09/PY for the methotrexate group and 0.09/PY for the mycophenolate mofetil group).
  
  
  CONCLUSIONS
  These data suggest that the time to control of ocular inflammation is faster with mycophenolate than with methotrexate. Azathioprine therapy has a higher rate of treatment-related side effects compared with the other 2 agents.
authors.affiliation: Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Anat
authors.initials: A
authors.lastname: Galor
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Jabs
authors.forename: Henry A
authors.initials: HA
authors.lastname: Leder
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Kedhar
authors.forename: James P
authors.initials: JP
authors.lastname: Dunn
authors.forename: George B
authors.initials: GB
authors.lastname: Peters
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Thorne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000963:Antimetabolites / Q000009:adverse effects / Q000627:therapeutic use*; D001379:Azathioprine / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007249:Inflammation / Q000188:drug therapy; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011241:Prednisone / Q000008:administration & dosage; D012189:Retrospective Studies; D015423:Scleritis / Q000188:drug therapy*; D014605:Uveitis / Q000188:drug therapy*
chemical_list: D000963:Antimetabolites; D005938:Glucocorticoids; D009173:Mycophenolic Acid; D001379:Azathioprine; D011241:Prednisone; D008727:Methotrexate