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G. A. Levy-Clarke, S. Gangaputra, C. W. Newcomb, D. A. Jabs, R. B. Nussenblatt, J. T. Rosenbaum, E. B. Suhler, J. E. Thorne, C. S. Foster, J. H. Kempen; Methotrexate for Ocular Inflammatory Diseases. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2023.
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To evaluate outcomes of methotrexate as a single immunosuppressive agent for non-infectious ocular inflammation.
A consecutive cohort of patients with non-infectious ocular inflammation was observed from initiation of methotrexate as a sole immunosuppressive agent at five tertiary uveitis clinics in the United States, between 1979-2007 inclusive. Data including dosage and route of administration of methotrexate, success in controlling inflammation, corticosteroid-sparing success (maintaining inflammatory control with 10 mg/day of prednisone or less), and discontinuation of methotrexate were obtained for every eye of every patient at every visit by medical record review.
Among 534 patients (919 eyes with inflammation) starting methotrexate monotherapy, 24%, 17.6%, 26.4%, 15.9%, 11.2%, and 4.7% respectively had anterior uveitis, intermediate uveitis, posterior or panuveitis, scleritis, ocular mucous membrane pemphigoid, and other forms of ocular inflammation. In these groups, complete suppression of inflammation sustained for ≥28 days was achieved in ≤6 months in 54.3%, 16.9%, 21.8%, 35.8%, 38.3%, and 76.7% respectively. Corticosteroid-sparing success sustained for ≥28 days was achieved in ≤6 months for 45.1%, 15.5%, 12.9%, 26.1%, 35.5%, and 47.8% respectively. Methotrexate was discontinued within ≤1 year by 42% of patients. Side effects, which led to discontinuation in 83 patients (16%), were typically reversible.
Methotrexate as a single immunosuppressive agent was reasonably effective for management of anterior uveitis, modestly effective for scleritis and mucous membrane pemphigoid, and less effective for intermediate uveitis and posterior or panuveitis. However, results were substantially better using less stringent success criteria. Methotrexate was well tolerated by the large majority of patients, and appears to convey little risk of serious side effects.
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