title: Success with single-agent immunosuppression for multifocal choroidopathies.
abstract: OBJECTIVE
  To evaluate the success of single-agent immunosuppression for patients with the posterior uveitides, birdshot chorioretinitis, multifocal choroiditis with panuveitis, and punctate inner choroiditis.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  setting: Tertiary care uveitis practices. population: Patients initiated on immunomodulatory therapy. intervention: Patients were treated with prednisone 1 mg/kg and mycophenolate 2 g daily. Prednisone was tapered after 1 month. Immunosuppression was escalated to mycophenolate 3 g daily, with addition of a second agent, as needed, to achieve treatment success. outcome measure: Treatment success, defined as no disease activity with prednisone dose ≤10 mg daily, at 6, 12, and 24 months.
  
  
  RESULTS
  Twenty-seven patients were followed. Mean presentation and 2-year follow-up acuities were 20/41 and 20/42, respectively. For birdshot chorioretinitis, mean (±standard deviation) quantitative Goldmann visual field scores improved from 761 ± 69 degrees (IV/4 isopter) and 496 ± 115 degrees (I/4 isopter) at presentation to 784 ± 57 degrees and 564 ± 125 degrees, respectively. Prednisone was successfully tapered in 95% of patients; mean prednisone doses at 1 and 2 years were 5.3 ± 4.1 and 5.7 ± 4.8 mg/day, respectively. At 2 years, prednisone was discontinued in 11% of patients. Treatment success was achieved in 74% of patients on 1 immunosuppressant, and in an additional 21% of patients on 2 agents, for an overall 95% success rate at 2 years.
  
  
  CONCLUSIONS
  Posterior uveitides can be treated with 1 agent in most patients, but the data suggest a need to escalate therapy to higher mycophenolate doses, and in one fifth of cases to add a second agent to maintain disease suppression with acceptably low prednisone doses.
authors.affiliation: Department of Ophthalmology, The Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Naomi R
authors.initials: NR
authors.lastname: Goldberg
authors.affiliation: Department of Ophthalmology, The Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Theodore
authors.initials: T
authors.lastname: Lyu
authors.affiliation: Department of Biostatistics, The Icahn School of Medicine at Mount Sinai, New York, New York; Institute for Translational Epidemiology, The Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Erin
authors.initials: E
authors.lastname: Moshier
authors.affiliation: Department of Biostatistics, The Icahn School of Medicine at Mount Sinai, New York, New York; Institute for Translational Epidemiology, The Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: James
authors.initials: J
authors.lastname: Godbold
authors.affiliation: Department of Ophthalmology, The Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York; Institute for Translational Epidemiology, The Icahn School of Medicine at Mount Sinai, New York, New York; Center for Clinical Trials, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: douglas.jabs@mssm.edu.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Jabs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000627:therapeutic use; D002825:Chorioretinitis / Q000188:drug therapy* / Q000503:physiopathology; D002833:Choroiditis / Q000188:drug therapy / Q000503:physiopathology; D004359:Drug Therapy, Combination; D004596:Electroretinography; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D000080364:Multifocal Choroiditis; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D015864:Panuveitis / Q000188:drug therapy* / Q000503:physiopathology; D011241:Prednisone / Q000627:therapeutic use*; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use; D014792:Visual Acuity / Q000502:physiology; D014794:Visual Fields / Q000502:physiology
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D001379:Azathioprine; D011241:Prednisone; D016559:Tacrolimus