title: Methotrexate as a Corticosteroid-Sparing Agent for Thyroid Eye Disease.
abstract: OBJECTIVE
  Thyroid eye disease (TED) is generally treated with oral corticosteroid therapy. A steroid sparing drug could be a useful adjunct. We reviewed our experience with methotrexate as a corticosteroid sparing agent to treat TED.
  
  
  METHODS
  Retrospective chart review from two eye inflammation clinics. Patients with TED who were unable to discontinue prednisone therapy without disease recurrence were included.
  
  
  RESULTS
  14 patients who were receiving an average of 32 mg/day of prednisone were treated with methotrexate, usually 15 mg/week orally or 20 mg/week subcutaneously. Five patients discontinued therapy for a lack of benefit or intolerance. Of the 9 patients who remained on methotrexate, all were able to discontinue prednisone completely after an average duration of 7.5 months. Improved visual acuity by at least two lines on the Snellen chart was achieved by 7 of 12 patients with reduced acuity and partial improvement in ocular motility was achieved in 5 of 14 patients.
  
  
  CONCLUSIONS
  Methotrexate provided an effective steroid sparing effect in a subset of patients with TED.
authors.affiliation: Ponce Health Science University, Ponce, Puerto Rico.
authors.forename: Erick
authors.initials: E
authors.lastname: Rivera-Grana
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Phoebe
authors.initials: P
authors.lastname: Lin
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA; Portland VA Health Care System, Portland, Oregon, USA.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Suhler
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA; Legacy Devers Eye Institute, Portland, Oregon, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: Rosenbaum
keywords: Corticosteroids; Graves' disease; Immunosuppression; Methotrexate; Prednisone; Thyroid eye disease