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R.N. Vianna, P.C. Ozdal, J. Deschênes, M.N. Burnier, Jr.; The Combination of Azathioprine and Corticosteroids in the Treatment of Serpiginous Choroiditis . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2423.
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The therapy with immunosuppressive agents is currently accepted as the best option to treat active serpiginous choroiditis (SC). Nevertheless, no consensus exists for the best immunosuppressive drug for SC. In this paper we describe the clinical course of patients with active SC treated with azathioprine (AZA) in combination with corticosteroids.
This is a retrospective study that included four patients (five eyes) with the diagnosis of active, vision–threatening SC who received systemic immunosuppression (AZA 1,5–2,0 mg/Kg/day). In combination with oral AZA, all patients received oral prednisone (1mg/Kg/day). Information collected included Snellen visual acuity (VA), clinical disease activity, duration of follow–up, rate of inflammation recurrences, and side effects of AZA.
Within 3 weeks of treatment all patients had decreased ocular inflammation and improved VA. However, one patient had a recurrence in both eyes while oral prednisone was being tapered. In this particular case, once the oral prednisone dose was increased and methotrexate was added to the therapeutic scheme, the inflammation was controlled within one month. The other three patients presented no further visual loss while on AZA, and were able to taper and then discontinue oral prednisone. Nevertheless, SC recurred in one these patients after 40 months without taking AZA. This medication was reintroduced but the patient complained of gastrointestinal problems. AZA was then successfully replaced by mycophenolate mofetil. None of four patients presented serious systemic side effects secondary to AZA.
This study suggests that AZA is a safe drug and when used in combination with corticosteroids is an acceptable option to treat patients with active SC. However, side effects and recurrences while on AZA therapy may occur, requiring the replacement of the drug or the addition of other immunosuppressive agent.
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