Characteristics of patients who attain remission of inflammatory eye disease following treatment and discontinuation of methotrexate

Abstract

Purpose: Immunomodulatory therapy (IMT) is becoming an increasingly used treatment for inflammatory eye disease. This study investigated the clinical course of patients with inflammatory eye diseases who were treated with methotrexate, obtained remission and were subsequently followed after discontinuation of the medication. The purpose of the study was to determine the characteristics of patients who stay in remission versus develop recurrences.

Methods: A retrospective chart review was conducted on a cohort of 50 patients with inflammatory eye disease treated with methotrexate at a tertiary care center. Patients who were treated with methotrexate until their inflammatory eye disease was inactive were reviewed for up to two years following the discontinuation of methotrexate for recurrence. Factors examined included age, sex, length of methotrexate treatment and concurrent or serial use of other IMT.

Results: 80% of the patients reviewed were female; 20% were male. Average age of patients was 39 years old (range 4-74). Average length of methotrexate treatment was 2.2 years (range 0.6 to 5.1). 16% of patients were treated with concurrent or serial IMT. 65% of female patients and 5% of male patients attained remission at two years. Average age of patients who attained remission at two years was 39 years old (range 4-74). Average age of patients who developed recurrent disease within two years was 40 years old (range 6-72). Average length of methotrexate treatment in patients who attained remission at two years was 1.9 years (range 0.8-4.3). Average length of methotrexate treatment in those who developed recurrent disease within two years was 2.6 years (0.6-5.1). 66% of patients on concurrent or serial use of other IMT and 64% of patients on methotrexate alone attained remission at two years.

Conclusions: Female patients were more likely than male patients to attain remission at two years. The average length of methotrexate treatment in patients who developed recurrence within two years was greater than those who attained remission at two years, but this difference was not statistically significant and may be related to cases that were more difficult to control. Age and concurrent or serial use of other IMT were not associated with remission or recurrence. These results may help ophthalmologists in their treatment and counseling of patients with inflammatory eye disease.

Keywords: 746 uveitis-clinical/animal model • 555 immunomodulation/immunoregulation • 557 inflammation