Cyclosporine for ocular inflammatory diseases.
OBJECTIVE
To evaluate the clinical outcomes of cyclosporine treatment for noninfectious ocular inflammation.


METHODS
Retrospective cohort study.


METHODS
A total of 373 patients with noninfectious ocular inflammation managed at 4 tertiary ocular inflammation clinics in the United States observed to use cyclosporine as a single noncorticosteroid immunosuppressive agent to their treatment regimen, between 1979 and 2007 inclusive.


METHODS
Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics, including dosage of cyclosporine and main outcome measures, were obtained for every eye of every patient at every visit via medical record review by trained expert reviewers.


METHODS
Control of inflammation, sustained control after reducing corticosteroid dosages, and discontinuation of therapy because of toxicity.


RESULTS
Of the 373 patients (681 eyes) initiating cyclosporine monotherapy, 33.4% by 6 months and 51.9% by 1 year gained sustained, complete control of inflammation over at least 2 visits spanning at least 28 days. Approximately 25% more improved to a level of slight inflammatory activity by each of these time points. Corticosteroid-sparing success (completely controlled inflammation for at least 28 days with prednisone < or = 10 mg/day) was achieved by 22.1% by 6 months and 36.1% within 1 year. Toxicity led to discontinuation of therapy within 1 year by 10.7% of the population. Patients aged more than 55 years were more than 3-fold more likely to discontinue therapy because of toxicity than patients aged 18 to 39 years. Doses of 151 to 250 mg/day tended to be more successful than lower doses and were not associated with a higher discontinuation for toxicity rate; higher doses did not seem to offer a therapeutic advantage.


CONCLUSIONS
Cyclosporine, with corticosteroid therapy as indicated, was modestly effective for controlling ocular inflammation. Our data support a preference for cyclosporine adult dosing between 151 and 250 mg/day. Although cyclosporine was tolerated by the majority of patients, toxicity was more frequent with increasing age; alternative agents may be preferred for patients aged more than 55 years.
Kaçmaz
R Oktay
RO
Department of Ophthalmology, The Mount Sinai School of Medicine, New York, New York, USA.
Kempen
John H
JH
Newcomb
Craig
C
Daniel
Ebenezer
E
Gangaputra
Sapna
S
Nussenblatt
Robert B
RB
Rosenbaum
James T
JT
Suhler
Eric B
EB
Thorne
Jennifer E
JE
Jabs
Douglas A
DA
Levy-Clarke
Grace A
GA
Foster
C Stephen
CS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007249:Inflammation / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010390:Pemphigoid, Benign Mucous Membrane / Q000188:drug therapy; D012189:Retrospective Studies; D015423:Scleritis / Q000188:drug therapy*; D016896:Treatment Outcome; D014605:Uveitis / Q000188:drug therapy*; D055815:Young Adult
D007166:Immunosuppressive Agents; D016572:Cyclosporine