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Alaa E. Radwan, Ravi Parikh, Ujwala Baheti, Matthew Austin, C. Stephen Foster; Risk factors associated with relapse of Birdshot Retinochoriodopathy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2793.
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To evaluate the risk factors associated with relapse among patients with Birdshot Retinochoroidopathy (BSRC) after treatment with immunomodulatory therapy (IMT) and in remission off immunomodulatory therapy for one year.
We undertook a e chart review of 114 patients with Birdshot Retinochoroidopathy treated at MERSI between 2005 to 2011. Out of these we included 37 patients who were treated successfully with immunomodulatory therapy and who remained in remission for one year off all immunomodulatory drugs. We further divided them into two groups. Group A included 27 patients who continued to be in remission until the last date of follow up. Group B included 10 patients who had a relapse of the disease. We compared the two groups for possible risk factors associated with relapse. The factors that were studied were age, gender, family or personal history of immune disease, HLA-A29 status, visual acuity at presentation, corticosteroid treatment, types of immunomodulatory therapy used, duration of each treatment, and duration of remission. Analysis was performed using logistic regression, exact logistic regression to account for small sample size, and survival analysis using Kaplan Meier curves and COX proportional hazard models.
Of 114 patients with BSRC since 2005, 37 patients were successfully treated to disease remission with immunomodulatory therapy and were in drug free remission of 1 year after treatment (32.4%). Twenty seven patients (23.6%) continue to be in remission to the present date. Ten (8.7%) relapsed. Using Cox proportional hazard models, we found patients who received oral corticosteroids or ocular injections of steroids were more likely to relapse than patients who did not receive corticosteroids (P=0.0201 and P=0.0187). Increased duration of IMT prior to remission was found to have significant protective effect against relapse (P=0.0486). No other factors were found to predict likelihood of relapse.
BSRC patients who received longer duration of immunomodulatory therapy prior to remission had less chance of relapse than those with shorter duration of IMT. Further, those patients who received oral or periocular corticosteroids were significantly associated with risk of relapse.
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