Duration of Immunomodulator Therapy on Five-Year Uveitis Remission Rates

Abstract

Purpose: To evaluate the relationship between duration of immunomodulator therapy (IMT) and uveitis remission rates five years after discontinuation of the IMT

Methods: 1424 charts were retrospectively reviewed from patients with anterior, intermediate, posterior and pan-uveitis seen in the uveitis service at New York Eye and Ear Infirmary between 2004 and 2007. Of these, 240 were identified as patients who had been on IMT with either methotrexate and/or mycophenolate mofetil. Only the 63 patients who had a minimum five-year follow-up period after the cessation of the IMT were included in the study. These patients were then divided into four groups based on the duration of time they were continuously treated with IMT: 0 to <1 year, 1 to <2 years, 2 to <3 years and greater than 3 years. Each patient’s record was reviewed to determine if he/she remained in remission for the entirety of the five year period following cessation of IMT.

Results: Of the patients included in the study, 21 were on mycophenolate mofetil (33%) and 42 (67%) were on methotrexate. In the 0-1 year IMT duration, three of thirteen patients (23%) remained in remission during the five years following cessation of IMT, and in the 1-2 year duration, six of fifteen patients (40%) remained in remission. Patients on longer periods of IMT achieved somewhat higher rates of remission after five years with seven out of sixteen (44%) within the 2-3 year group and nine of nineteen (47%) in the greater than 3 year group. This difference is not statistically significant (chi-square 2.0778, p=0.56).

Conclusions: This pilot study could not show a statistical difference in the length of remission after discontinuation of immunomodulatory therapy in uveitis patients whether the patients had been on treatment for less than one, one to two, two to three, or greater than three years. This current study is, however, limited by the small number of patients, and a more definitive answer to this question would require a prospective study with a larger sample size.