Azathioprine for ocular inflammatory diseases.
OBJECTIVE
To evaluate treatment outcomes of azathioprine for noninfectious ocular inflammatory diseases.


METHODS
Retrospective cohort study.


METHODS
Medical records of 145 patients starting azathioprine as a sole noncorticosteroid immunosuppressant at 4 tertiary uveitis services were reviewed. Main outcome measures included control of ocular inflammation, sustained control after tapering prednisone to </= 10 mg/day, and discontinuation of treatment because of side effects.


RESULTS
Among 145 patients (255 eyes) treated with azathioprine, 63% had uveitis, 23% had mucous membrane pemphigoid, 11% had scleritis, and 3% had other inflammatory diseases. By Kaplan-Meier analysis, 62% (95% confidence interval [CI], 50% to 74%) of patients with active disease initially gained complete inactivity of inflammation sustained over at least 28 days within 1 year of therapy, and 47% (95% CI, 37% to 58%) tapered systemic corticosteroids to </= 10 mg daily while maintaining control of inflammation within 1 year of therapy. Treatment success was most common for intermediate uveitis (90% with sustained inactivity within 1 year; 95% CI, 64% to 99%). Over the median follow-up of 230 days (interquartile range, 62 to 679 days), azathioprine was discontinued at a rate of 0.45 per person-years (/PY): 0.16/PY because of side effects, 0.10/PY because of ineffectiveness, 0.09/PY because of disease remission, and 0.10/PY because of unspecified causes.


CONCLUSIONS
Azathioprine was moderately effective as a single corticosteroid-sparing immunosuppressive agent in terms of control of inflammation and corticosteroid-sparing benefits, but required several months to achieve treatment goals; it seems especially useful for patients with intermediate uveitis. Treatment-limiting side effects occurred in approximately one-fourth of patients within 1 year, but typically were reversible.
Pasadhika
Sirichai
S
Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA.
Kempen
John H
JH
Newcomb
Craig W
CW
Liesegang
Teresa L
TL
Pujari
Siddharth S
SS
Rosenbaum
James T
JT
Thorne
Jennifer E
JE
Foster
C Stephen
CS
Jabs
Douglas A
DA
Levy-Clarke
Grace A
GA
Nussenblatt
Robert B
RB
Suhler
Eric B
EB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001379:Azathioprine / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; 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; D010390:Pemphigoid, Benign Mucous Membrane / Q000188:drug therapy*; D011241:Prednisone / Q000627:therapeutic use; D012189:Retrospective Studies; D015423:Scleritis / Q000188:drug therapy*; D016896:Treatment Outcome; D014605:Uveitis / Q000188:drug therapy*; D055815:Young Adult
D007166:Immunosuppressive Agents; D001379:Azathioprine; D011241:Prednisone