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Margot Lazow, Stephen Kim; Incidence and Risk Factors for Recurrent Uveitis after Long-term Treatment. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5326.
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To determine the incidence and associated risk factors for recurrent uveitis in patients with autoimmune chronic uveitis with at least 12 months of inactive disease on immunosuppression followed by elective cessation of treatment.
This was a retrospective cohort study. Records of 1,901 patients with ICD-9 codes for uveitis were reviewed, and 42 eyes of 23 patients (1.21%) met inclusion criteria. Patients were included if they had non-infectious, autoimmune chronic uveitis diagnosed by a fellowship-trained uveitis specialist, and were inactive for at least 12 months on immunosuppression before cessation of treatment, with at least 6 months of follow-up. Subject characteristics, lab data, and documented clinic visits were reviewed and recorded from the Vanderbilt Medical Center's electronic medical record. Descriptive statistics including mean and standard deviation were calculated for case characteristics, and the Fisher exact test was used to compare categorical values between remission and recurrence eyes. Main outcome measures were incidence of recurrent inflammation after cessation of treatment and predisposing risk factors.
Uveitis recurred in 15 of 42 eyes (35.7%). Eyes with anterior uveitis were less likely to recur than eyes with intermediate, pan, or posterior uveitis (RR: 0.18, p<0.05). The recurrence group was more likely to have stopped immunosuppression at a younger age (<25y/o) (p<0.05); average age of immunosuppression cessation was 29.1±19.1 for the recurrence eyes, vs. 42.2±21.4 for the remission eyes. In addition, we noted two trends: females seemed more likely to recur than males (p =0.11), and eyes that started immunosuppression <1 year after disease onset seemed more likely to recur (vs. >1yr) (p=0.11). Also, there was no significant difference in duration of inactive disease on immunosuppression (before cessation) between the two groups (18.0±3.9 vs. 19.0±6.3 months, p=0.58). Lastly, of the eyes that recurred, 100% recurred within 12 months of stopping immunosuppression, and 67% recurred within 6 months.
Uveitis recurred in approx. 1 of 3 eyes, and 100% of these recurrences occurred within 1 year of stopping immunosuppression. Risk characteristics for recurrence include non-anterior uveitis and stopping immunosuppression at a younger age. Duration of inactive disease on immunosuppression before cessation was not a significant factor.
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