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Mehrine Shaikh, Sana Siddique, Mark Dacey, C. Stephen Foster; Cytosine Arabinoside for the treatment of Ocular Inflammatory disorders: a pilot study. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2546.
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To ascertain the outcomes of Arabinoside Cytarabine as either monotherapy or combination therapy in the treatment of severe ocular inflammatory disease refractory to multiple traditional chemotherapies. This paper represents the first published cases examining the efficacy and tolerance of treatment with cytosine arabinoside in patients with ocular inflammatory disease.
This is a single-center, retrospective interventional case series. The charts of 7 patients with noninfectious uveitis who treated with Arabinoside Cytarabine (Ara-C) after failing treatment with conventional immunomodulatory therapy were reviewed. Primary outcome measure was inflammatory status while on Ara C therapy. Secondary outcome measure was adverse effects.
In this small retrospective study of seven patients, Ara-C has been shown to be effective in inducing durable steroid-free remission from noninfectious ocular inflammatory conditions in 3 of 7 patients(42.9%), with well-tolerated treatment regimens lasting 1-2 years. In 2 out of 7 patients (28.6%), the inflammation was not adequately controlled with Ara-C and ultimately required intravenous cyclophosphamide. 2 out of 7 patients(28.6%) stopped Ara-C infusions due to systemic side effects; one developed new anemia after the onset of Ara-C infusions, and a second developed a persistent axillary abscess that eventually required surgical incision and drainage. Ara-C was generally well tolerated at doses of 100-200 mg/month as both monotherapy and combination therapy, with two patients noting mild nausea after infusions which did not preclude additional infusions.
We present these cases to introduce Arabinoside Cytarabine as another option for immunomodulatory therapy in the treatment of ocular inflammatory disease, particularly for patients with persistently stubborn inflammation that has not been placed into remission with multiple prior chemotherapies. This study reveals that Ara-C is a safe and effective immunomodulatory therapeutic option.
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