April 2009
Volume 50, Issue 13
ARVO Annual Meeting Abstract  |   April 2009
Methotrexate for Ocular Inflammatory Diseases
Author Affiliations & Notes
  • G. A. Levy-Clarke
    St Lukes Cataract and Laser Institute, St petersburg, Florida
  • S. Gangaputra
    UW-Dept of Ophthalmology and Visual Sc, Fundus Photograph Reading Center, Wisconsin
  • C. W. Newcomb
    Dept of Biostatistics and Epidemiology, University of Pennsylvania, Pennsylvania
  • D. A. Jabs
    Dept of Ophthalmology, Mt Sinai School of Medicine, New York
  • R. B. Nussenblatt
    Lab of Immunology, National Eye Institute, Maryland
  • J. T. Rosenbaum
    Dept of Ophthalmology & Medicine, Oregon Health & Science University, Oregon
  • E. B. Suhler
    Dept of Ophthalmology, Oregon Health & Science University, Florida
  • J. E. Thorne
    Dept of Ophthalmology, Johns Hopkins School of Medicine, Maryland
  • C. S. Foster
    Massachusetts Eye Research and Surgery Institute, Cambridge, Massachusetts
  • J. H. Kempen
    Dept of Ophthalmology, University of Pennsylvania, Pennsylvania
  • Footnotes
    Commercial Relationships  G.A. Levy-Clarke, None; S. Gangaputra, None; C.W. Newcomb, None; D.A. Jabs, None; R.B. Nussenblatt, None; J.T. Rosenbaum, None; E.B. Suhler, None; J.E. Thorne, None; C.S. Foster, None; J.H. Kempen, None.
  • Footnotes
    Support  NIH Grant EY014943, Research to Prevent Blindness, Mackall Foundation
Investigative Ophthalmology & Visual Science April 2009, Vol.50, 2023. doi:
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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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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: : To evaluate outcomes of methotrexate as a single immunosuppressive agent for non-infectious ocular inflammation.

Methods: : 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.

Results: : 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.

Conclusions: : 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.

Keywords: uveitis-clinical/animal model • clinical (human) or epidemiologic studies: outcomes/complications • drug toxicity/drug effects 

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