title: Efficacy and safety of immunosuppressive agents in the treatment of necrotising scleritis: a retrospective, multicentre study in Korea.
abstract: OBJECTIVE
  To investigate the efficacy and safety of cyclophosphamide and other immunosuppressive agents (ISAs) in the treatment of necrotising scleritis.
  
  
  METHODS
  We reviewed the medical records of patients with necrotising scleritis at 11 tertiary care centres in South Korea from 2002 to 2012, treated with ISAs within 3 months of follow-up period. We divided patients into two groups: a group treated with cyclophosphamide (CYC group) and a group treated with other ISAs; azathioprine, ciclosporin, methotrexate and mycophenolate mofetil (OISA group). Main outcome measures evaluated were remission rate, relapse rate, rate of visual loss, steroid-sparing rate, adverse effects and discontinuation of medication due to adverse effects.
  
  
  RESULTS
  CYC group had a remission in 95.2% of the patients and OISA group had in 96.3%. Remission rate, relapse rate, visual loss rate and steroid-sparing rate were not significantly different between the two groups (all p>0.05). The median duration of steroid use was longer in CYC group than in other OISA group (55 vs 16 days, p=0.09). The incidence of adverse effects in the CYC group was comparable with that of the OISA group (61.9% vs 41.4%, p=0.15). However, the incidence of leucopenia, haemorrhagic cystitis and discontinuation of medication due to adverse effects were much higher in the CYC group (p<0.001, p<0.001, p=0.05, respectively).
  
  
  CONCLUSIONS
  The efficacy of cyclophosphamide in the treatment of necrotising scleritis was comparable with that of other ISAs. However, the rate of discontinuation due to side effects was much higher in the CYC group.
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Hyun Sun
authors.initials: HS
authors.lastname: Jeon
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Joon Young
authors.initials: JY
authors.lastname: Hyon
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Mee Kum
authors.initials: MK
authors.lastname: Kim
authors.affiliation: Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Tae-Young
authors.initials: TY
authors.lastname: Chung
authors.affiliation: Department of Ophthalmology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Kyung Chul
authors.initials: KC
authors.lastname: Yoon
authors.affiliation: Department of Ophthalmology, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Jae Yong
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Ophthalmology, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea.
authors.forename: Kyung-Sun
authors.initials: KS
authors.lastname: Na
authors.affiliation: Department of Ophthalmology, Catholic University of Daegu School of Medicine, Daegu Catholic Hospital, Daegu, Korea.
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Ophthalmology, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea.
authors.forename: Tae-Im
authors.initials: TI
authors.lastname: Kim
authors.affiliation: Department of Ophthalmology, Pusan National University College of Medicine, Pusan National University Hospital & Medical Research Institute, Pusan, Korea.
authors.forename: Jong Soo
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea.
authors.forename: Hyung Keun
authors.initials: HK
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea.
authors.forename: Jong Suk
authors.initials: JS
authors.lastname: Song
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015423:Scleritis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide
keywords: Immunology; Inflammation; Pharmacology; Sclera and Episclera; Treatment Medical