Retention time for corticosteroid-sparing systemic immunosuppressive agents in patients with inflammatory eye disease

• Published in: British journal of ophthalmology 2006-12, Vol.90 (12), p.1481-1485
• Main Authors: Baker, K B, Spurrier, N J, Watkins, A S, Smith, J R, Rosenbaum, J T
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Child; Child, Preschool; Chronic illnesses; Clinical Science - Extended Report; Clinical trials; Data collection; Drug Administration Schedule; Drug Evaluation; Endophthalmitis - drug therapy; Epidemiologic Methods; Eye diseases; Family medical history; Female; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Inflammatory diseases; Male; Medical sciences; Methods; Methotrexate - administration & dosage; Methotrexate - adverse effects; Middle Aged; Miscellaneous; Ophthalmology; Patient Compliance - statistics & numerical data; Patient Dropouts - statistics & numerical data; Patients; Prescription drugs; Quality of life; Retention; Studies; Treatment Outcome; Uveitis - drug therapy
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjo.2006.097998

Background: Multiple immunosuppressive drugs have been used to manage inflammatory eye disease when control cannot be achieved by corticosteroid alone. However, although clinical studies support the effectiveness of most of these agents, comparative studies have not been undertaken. Retention time, a measure of the duration of treatment with any given drug, is a crude indicator of drug effectiveness and tolerability that facilitates such a comparison. The retention time was compared for corticosteroid-sparing immunosuppressive agents in patients attending our tertiary referral inflammatory eye disease clinic. Methods: The clinical records of all patients attending an inflammatory eye disease clinic at the Casey Eye Institute over a 1-year period (2003) were reviewed. From these records, we collected the following clinical data: age; sex; ocular diagnosis; and use of steroid-sparing systemic immunosuppression, including drugs, duration of treatment and, if ceased, reasons for cessation. Cox regression analysis, adjusted for clustering, was used to compare other drugs against methotrexate. Results: 107 of 302 (35%) patients seen at the inflammatory eye disease clinic in 2003 had a total of 193 current or past prescriptions for systemic steroid-sparing immunosuppressive agents. The treated group, most of whom had uveitis, included 32 men and 75 women, aged 5–86 years. Most commonly prescribed were methotrexate (66 uses, 34%), ciclosporin (37 uses, 19%), azathioprine (26 uses, 13%), mycophenolate mofetil (22 uses, 11%) and cyclophosphamide (15 uses, 8%). Patients were retained significantly less on ciclosporin (p = 0.004), azathioprine (p = 0.04), mycophenolate mofetil (p = 0.04) and cyclophosphamide (p