title: Outcomes of changing immunosuppressive therapy after treatment failure in patients with noninfectious uveitis.
abstract: OBJECTIVE
  To evaluate the outcomes of changing immunosuppressive therapy for noninfectious uveitis after failure.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Patients with noninfectious uveitis managed at 2 tertiary uveitis clinics in the United Kingdom and Australia.
  
  
  METHODS
  Participants with a history of using immunosuppressive therapy were identified in clinics, and notes were reviewed by doctors trained in uveitis therapy. Each treatment episode/course (starting or changing a therapy) was identified, and demographic details, clinical characteristics, drug used (second-line immunosuppressive agent [ISA] or biologicals), and drug doses were obtained.
  
  
  METHODS
  For each treatment episode, the reasons for changing therapy, corticosteroid-sparing effects, and control of inflammation were determined.
  
  
  RESULTS
  A total of 147 patients were identified who underwent 309 different treatment episodes. Fifty-five percent of patients eventually required a change in treatment after their first treatment episode/course. Forty-five episodes involved switching from one ISA to another, with 50% to 100% of these patients achieving "success" (prednisolone ≤10 mg and sustained control) with the new ISA. A combination of ISAs were used in 53 episodes, with "success" being achieved in 50% to 71% of these patients. Biological agents were used in 45 episodes, the most common one being infliximab, which achieved success in 80% of patients.
  
  
  CONCLUSIONS
  Our data suggest that control of inflammation can be achieved after switching or combining ISAs.
authors.affiliation: Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom.
authors.forename: Lavnish
authors.initials: L
authors.lastname: Joshi
authors.affiliation: Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom.
authors.forename: Lazha
authors.initials: L
authors.lastname: Talat
authors.affiliation: Royal Surrey County Hospital, Guildford, United Kingdom.
authors.forename: Satish
authors.initials: S
authors.lastname: Yaganti
authors.affiliation: Save Sight Institute, Sydney Eye Hospital, Sydney, Australia.
authors.forename: Sartaj
authors.initials: S
authors.lastname: Sandhu
authors.affiliation: Royal Surrey County Hospital, Guildford, United Kingdom; Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom.
authors.forename: Simon R J
authors.initials: SR
authors.lastname: Taylor
authors.affiliation: School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: Denis
authors.initials: D
authors.lastname: Wakefield
authors.affiliation: Save Sight Institute, Sydney Eye Hospital, Sydney, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: McCluskey
authors.affiliation: Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom. Electronic address: s.lightman@ucl.ac.uk.
authors.forename: Susan
authors.initials: S
authors.lastname: Lightman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016572:Cyclosporine / Q000627:therapeutic use; D057915:Drug Substitution; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D014605:Uveitis / Q000188:drug therapy* / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone; D009173:Mycophenolic Acid; D001379:Azathioprine; D008727:Methotrexate