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K. Quinones, P. Bhat, C. Foster; High Dose Intravenous Methotrexate for the Treatment of Recalcitrant Ocular Inflammatory Diseases. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4740.
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To evaluate the outcomes and safety profile of intravenous methotrexate (IV-MTX) in patients with chronic, noninfectious ocular inflammation.
Retrospective chart review of patients with active ocular inflammatory disease that received IV-MTX. Subjects had failed or were intolerant to standard therapy, including oral and subcutaneous MTX. Blood counts and liver function tests were evaluated before each infusion. All subjects used daily folic acid supplements. Main outcome measures included corticosteroid sparing effect, changes in visual acuity (VA), control of inflammation. Any associated side effects were documented.
Eight patients (14 eyes) with a mean age of 57.4 years received an average of 6.1 ± 3.6 infusions (25-100 mg) of IV-MTX every 1 to 3 weeks. Patients presented with scleritis (n=2), panuveitis (n=2), anterior (n=3), and intermediate (n=1) uveitis associated to rheumatoid arthritis, psoriasis, Behcet’s disease, multiple sclerosis, and Ocular Cicatricial Pemphigoid. Over a period of 5.8 ± 0.88 months, disease activity improved in 78.6% of eyes and oral corticosteroids were discontinued in all patients. Topical corticosteroid therapy decreased in 12 of 13 eyes. Visual acuity was improved or maintained in 92.8% of eyes. Average VA, in LogMAR units, improved from 0.54 ± 0.60 at baseline to 0.39 ± 0.48, 0.35 ± 0.69 and 0.40 ± 0.75 at 1, 3, and 5 months, respectively. Three patients underwent successful cataract surgery. IV-MTX was interrupted in one patient with transient leukopenia and discontinued in 1 case in a patient with uncontrolled inflammation that required stronger immunomodulation.
Intravenous methotrexate appears to be a well-tolerated and useful treatment agent for refractory ocular inflammation. Additional multi-centered clinical trials with extended follow-up periods should be encouraged.
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