Induction of durable remission in ocular inflammatory diseases.
OBJECTIVE
To describe a paradigm of care for patients with ocular inflammatory diseases aimed at induction of durable remission.


METHODS
Retrospective cohort study. The records of 399 patients with ocular inflammatory diseases treated with systemic immunomodulatory therapy (IMT) at the Massachusetts Eye Research and Surgery Institution were reviewed. Durable remission was defined as control of inflammation in the absence of systemic IMT for at least 1 year. Fifty patients met the inclusion criteria.


RESULTS
Mean age was 46+/-22.5 years (range 18-88). All the patients had corticosteroid therapy and failed this therapy before having IMT. Fifty-two percent of the patients had used methotrexate alone or in combination with other medications. Thirty percent of the patients required at least 2 years of therapy with systemic IMT to obtain durable remission, while 44% required 2 to 5 years of therapy to achieve the same. Twenty percent continued to stay in remission, off immunomodulatory drugs, between 2 and 5 years and 18% were in remission for more than 5 years after therapy discontinuation.


CONCLUSIONS
IMT can be sight saving in patients. It can be tapered and discontinued successfully without the return of ocular inflammation. Durable drug-free remission is an achievable goal, and should be pursued by ocular inflammatory disease specialists.
Cervantes-Castaneda
R A
RA
Massachusetts Eye Research and Surgery Institution, Cambridge, MA 02142, USA.
Bhat
P
P
Fortuna
E
E
Acevedo
S
S
Foster
C S
CS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007249:Inflammation / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017211:Treatment Failure; D014605:Uveitis / Q000188:drug therapy* / Q000503:physiopathology; D055815:Young Adult
D007155:Immunologic Factors; D007166:Immunosuppressive Agents