Immunosuppressive Drug Discontinuation in Noninfectious Uveitis From Real-Life Clinical Practice: A Survival Analysis.
To assess in uveitis patients the rate of immunosuppressive drug (ISD) discontinuation in real-life clinical practice, comparing this rate among ISDs.



Longitudinal retrospective cohort study.



We included uveitis patients attending a tertiary eye referral center from Madrid (Spain) between 1989 and 2015, prescribed any ISDs (cyclosporine, methotrexate, azathioprine, anti-TNF drugs, or others). Our main outcome was discontinuation of all ISDs owing to clinical efficacy, inefficacy, adverse drug reaction (ADR), and other medical causes. Discontinuation rates (DRs) per 100 patient-years were estimated. Variables associated with specific-cause discontinuations were analyzed using Cox bivariate and multivariate models.



We analyzed 110 patients with 263 treatment courses and 665.2 patient-years of observation. Cyclosporine (66.4%), methotrexate (47.3%), azathioprine (30.9%), and anti-TNFs (30.9%) were the most frequently used ISDs. Treatment was suspended in 136 cases (mostly owing to clinical efficacy [38.2%], inefficacy [26.5%], and ADRs [22.8%]). All-cause DR with 95% confidence interval was 20.4 [17.3-24.2]. Retention rates at 1 and 10 years were 74% and 16%, respectively. In the multivariate analysis, combined treatment exhibited higher DRs owing to clinical efficacy than other ISDs in monotherapy. Conversely, nonbiologic combination therapy with azathioprine exhibited the highest DR owing to ADRs.



Clinical efficacy was the most frequent cause for ISD discontinuation, followed by inefficacy and ADRs. DR owing to efficacy was higher for combination therapy. Furthermore, nonbiologic combination therapy with azathioprine was associated with a higher DR owing to ADRs.
Rheumatology Department, Hospital Clínico San Carlos, Madrid, Spain; Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain. Electronic address: labasolo@salud.madrid.org.
Lydia
L
Abásolo
Rheumatology Department, Hospital Clínico San Carlos, Madrid, Spain.
Zulema
Z
Rosales
Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain; Ophthalmology Department, Hospital Clínico San Carlos, Madrid, Spain; Cooperative Research Network on Age-Related Ocular Pathology, Visual and Life Quality, Instituto de Salud Carlos III, Madrid, Spain.
David
D
Díaz-Valle
Rheumatology Department, Hospital Clínico San Carlos, Madrid, Spain.
Alejandro
A
Gómez-Gómez
Rheumatology Department, Hospital Clínico San Carlos, Madrid, Spain.
Rayma C
RC
Peña-Blanco
Rheumatology Department, Hospital Clínico San Carlos, Madrid, Spain.
Ángela
Á
Prieto-García
Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain; Ophthalmology Department, Hospital Clínico San Carlos, Madrid, Spain; Cooperative Research Network on Age-Related Ocular Pathology, Visual and Life Quality, Instituto de Salud Carlos III, Madrid, Spain.
José Manuel
JM
Benítez-Del-Castillo
Rheumatology Department, Hospital Clínico San Carlos, Madrid, Spain.
Esperanza
E
Pato
Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain; Ophthalmology Department, Hospital Clínico San Carlos, Madrid, Spain; Cooperative Research Network on Age-Related Ocular Pathology, Visual and Life Quality, Instituto de Salud Carlos III, Madrid, Spain.
Julián
J
García-Feijoo
Rheumatology Department, Hospital Clínico San Carlos, Madrid, Spain; Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain.
Benjamín
B
Fernández-Gutiérrez
Rheumatology Department, Hospital Clínico San Carlos, Madrid, Spain; Health Research Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain.
Luis
L
Rodriguez-Rodriguez
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014605:Uveitis / Q000188:drug therapy* / Q000401:mortality; D028761:Withholding Treatment / Q000706:statistics & numerical data; D055815:Young Adult
D007166:Immunosuppressive Agents