Discontinuous drug combination therapy in autoimmune ocular disorders.
OBJECTIVE
This study aimed to assess the effectiveness of a steroid-sparing immunosuppressive treatment (IST) protocol in the control of severe or steroid-resistant autoimmune ocular inflammatory diseases.


METHODS
We carried out a prospective, non-randomized clinical study. Patients presenting with ocular inflammations that failed to respond adequately to steroids alone after monotherapy for a mean period of 9 +/- 2 months (internal control) were offered the option to switch to a combined IST. The protocol consisted of different immunosuppressive drugs added in a stepladder sequence, where each drug (including the steroids) was administered discontinuously. Main outcome measures were control of inflammation, visual acuity and safety of treatment.


RESULTS
A total of 76 subjects (121 affected eyes) enrolled in the IST protocol. Mean length of follow-up was 43 +/- 15 months. Complete control of inflammation was achieved in 86% of patients. During the first year of IST, the rate of inflammatory recurrences/patient was 0.78 +/- 1.13. This ratio diminished further during succeeding follow-up. Mean best corrected visual acuity improved from 0.31 logMAR to 0.24 logMAR (p < 0.001). Blood pressure and uric acid blood levels significantly altered for the worse in the study group.


CONCLUSIONS
Immunosuppressive treatment was effective in achieving inflammatory quiescence in a large majority of patients. The study also demonstrated the longterm safety of the protocol and its steroid-sparing effect.
Orsoni
Jelka G
JG
Department of Cervico-Facial Sciences, Institute of Ophthalmology, University of Parma, Parma, Italy.
Zavota
Laura
L
Mora
Paolo
P
Rubino
Pierangela
P
Manzotti
Francesca
F
Pellistri
Isabella
I
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000188:drug therapy* / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005128:Eye Diseases / Q000188:drug therapy* / Q000503:physiopathology; D005139:Eyeglasses; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007249:Inflammation / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood; D014792:Visual Acuity / Q000187:drug effects; D055815:Young Adult
D007166:Immunosuppressive Agents; D013256:Steroids; D014527:Uric Acid