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Hyun Sun Jeon, Mee Kum Kim, Joon-Young Hyon; The efficacy and safety of immunosuppressive agents in the treatment of necrotizing scleritis - A multi-center retrospective analysis in Korea. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5795.
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Necrotizing scleritis is the most severe form of scleritis, however there have been only several small case reports regarding its treatment. We performed a multi-center, retrospective, case series study to investigate the efficacy and safety of immunosuppressive agents (ISA) in the treatment of necrotizing scleritis.
Medical charts of fifty-two patients treated with ISA for necrotizing scleritis from June 2002 to May 2012 at eleven tertiary-care centers were reviewed. Patient characteristics, clinical features, risk factors, and treatment results were analyzed. The efficacy and safety was evaluated and compared between cyclophosphamide and other ISA (azathioprine, cyclosporine, methotrexate, and mycophenolate mofetil). Efficacy was assessed by remission rate, relapse rate, visual loss (more than 2 lines) rate and steroid sparing rate. Safety was assessed by occurrence of adverse effects and discontinuation of medication from its adverse effects.
Of 52 patients, 50 who treated with ISA within 3 months periods were included. The mean age was 65.8 ± 10.5 years. Complete or partial remission was achieved in 90% of patients by 6 months and 95% by 12 months. Patients who were initially treated with ISA showed significantly better complete remission rate (P=0.043). There were no significant differences in remission rate, relapse rate, visual loss rate, and steroid sparing rate between cyclophosphamide group and other ISA group. Incidence of adverse effects were comparable between cyclophosphamide and other ISA (61.9% vs. 41.4%, P=0.152), however, incidence of leukopenia, hemorrhagic cystitis, and discontinuation of medication from adverse effects were much higher in cyclophosphamide group (P<0.001, P<0.001, P=0.05, respectively).
Initial treatment with ISA showed clinical benefit in the treatment of necrotizing scleritis. Although overall incidences of adverse effects were not different among agents, side effects related medication discontinuation was much higher with cyclophosphamide.
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