title: Ten-year experience of pulsed intravenous cyclophosphamide and methylprednisolone protocol (PICM protocol) in severe ocular inflammatory disease.
abstract: OBJECTIVE
  Severe ocular inflammation is a blinding ophthalmological emergency. This study evaluates the efficacy and patient tolerance of a validated regime of pulsed intravenous cyclophosphamide and methylprednisolone ('PICM protocol') for these patients.
  
  
  METHODS
  26 patients with severe inflammatory eye disease (43 eyes: 22 uveitis, 21 scleritis/sclerokeratitis; median age 52 years (IQR 40.25-62.25)) presenting to a regional tertiary referral centre were recruited over a 10-year period (January 2002-December 2011) into the PICM protocol, comprising intravenous cyclophosphamide 15 mg/kg, intravenous methylprednisolone 10 mg/kg, maximum nine pulses over 20 weeks supplemented with low-dose continuous oral prednisolone. Data were captured pretreatment and at 6 and 12 months follow-up. Primary outcome measures were control of inflammation according to standard criteria and reduction in systemic glucocorticoid to ≤10 mg prednisolone/day.
  
  
  RESULTS
  A median of six pulses (IQR 5-6) were administered over a median of 3 months (IQR 2.25-4). In the scleritis/sclerokeratitis group, 15/21(71%) achieved success or partial success at 6 and 12 months versus 9/22 (41%) for the same time points in the uveitis group (χ(2)=4.058, p=0.044). Two patients had adverse events requiring treatment withdrawal.
  
  
  CONCLUSIONS
  This PICM protocol is a well-tolerated regimen for managing severe ocular inflammation and appears particularly useful in patients with scleritis/sclerokeratitis.
authors.affiliation: Academic Unit of Ophthalmology, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, UK.
authors.forename: Imran J
authors.initials: IJ
authors.lastname: Khan
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Barry
authors.forename: Kwesi N
authors.initials: KN
authors.lastname: Amissah-Arthur
authors.forename: David
authors.initials: D
authors.lastname: Carruthers
authors.forename: Srinivasa Rao
authors.initials: SR
authors.lastname: Elamanchi
authors.forename: Deva
authors.initials: D
authors.lastname: Situnayake
authors.forename: Philip I
authors.initials: PI
authors.lastname: Murray
authors.forename: Alastair K
authors.initials: AK
authors.lastname: Denniston
authors.forename: Saaeha
authors.initials: S
authors.lastname: Rauz
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003520:Cyclophosphamide / Q000008:administration & dosage*; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007634:Keratitis / Q000188:drug therapy*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D015423:Scleritis / Q000188:drug therapy*; D014605:Uveitis / Q000188:drug therapy*
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D008775:Methylprednisolone