Cyclophosphamide for ocular inflammatory diseases.
OBJECTIVE
To evaluate the outcomes of cyclophosphamide therapy for noninfectious ocular inflammation.


METHODS
Retrospective cohort study.


METHODS
Two hundred fifteen patients with noninfectious ocular inflammation observed from initiation of cyclophosphamide.


METHODS
Patients initiating cyclophosphamide, without other immunosuppressive drugs (other than corticosteroids), were identified at 4 centers. Dose of cyclophosphamide, response to therapy, corticosteroid-sparing effects, frequency of discontinuation, and reasons for discontinuation were obtained by medical record review of every visit.


METHODS
Control of inflammation, corticosteroid-sparing effects, and discontinuation of therapy.


RESULTS
The 215 patients (381 involved eyes) meeting eligibility criteria carried diagnoses of uveitis (20.4%), scleritis (22.3%), ocular mucous membrane pemphigoid (45.6%), or other forms of ocular inflammation (11.6%). Overall, approximately 49.2% (95% confidence interval [CI], 41.7%-57.2%) gained sustained control of inflammation (for at least 28 days) within 6 months, and 76% (95% CI, 68.3%-83.7%) gained sustained control of inflammation within 12 months. Corticosteroid-sparing success (sustained control of inflammation while tapering prednisone to 10 mg or less among those not meeting success criteria initially) was gained by 30.0% and 61.2% by 6 and 12 months, respectively. Disease remission leading to discontinuation of cyclophosphamide occurred at the rate of 0.32/person-year (95% CI, 0.24-0.41), and the estimated proportion with remission at or before 2 years was 63.1% (95% CI, 51.5%-74.8%). Cyclophosphamide was discontinued by 33.5% of patients within 1 year because of side effects, usually of a reversible nature.


CONCLUSIONS
The data suggest that cyclophosphamide is effective for most patients for controlling inflammation and allowing tapering of systemic corticosteroids to 10 mg prednisone or less, although 1 year of therapy may be needed to achieve these goals. Unlike with most other immunosuppressive drugs, disease remission was induced by treatment in most patients who were able to tolerate therapy. To titrate therapy properly and to minimize the risk of serious potential side effects, a systematic program of laboratory monitoring is required. Judicious use of cyclophosphamide seems to be beneficial for severe ocular inflammation cases where the potentially vision-saving benefits outweigh the substantial potential side effects of therapy, or when indicated for associated systemic inflammatory diseases.
Pujari
Siddharth S
SS
The Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts, USA.
Kempen
John H
JH
Newcomb
Craig W
CW
Gangaputra
Sapna
S
Daniel
Ebenezer
E
Suhler
Eric B
EB
Thorne
Jennifer E
JE
Jabs
Douglas A
DA
Levy-Clarke
Grace A
GA
Nussenblatt
Robert B
RB
Rosenbaum
James T
JT
Foster
C Stephen
CS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003229:Conjunctival Diseases / Q000188:drug therapy* / Q000503:physiopathology; D003520:Cyclophosphamide / Q000627:therapeutic use*; D005128:Eye Diseases / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007249:Inflammation / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010390:Pemphigoid, Benign Mucous Membrane / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D015423:Scleritis / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D014605:Uveitis / Q000188:drug therapy* / Q000503:physiopathology; D055815:Young Adult
D007166:Immunosuppressive Agents; D003520:Cyclophosphamide