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K.M. Narayana, J. Wu, P. Latkany, S. Schwartzman, C.M. Samson; Immunomodulatory Therapy in Patients With Scleritis . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2833.
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Purpose: To evaluate the efficacy and safety of immunomodulatory agents in the treatment of non–infectious scleritis. Methods: This study was an open label, interventional, non–comparative retrospective series of patients with non–infectious refractory and or recurrent scleritis treated with immunomodulatory agents including methotrexate, cyclosporine, mycophenolate mofetil, etanercept, azathioprine, cyclophosphamide or a combination of such agents. After IRB approval, data including the intraocular inflammatory response, side–effects and toxicity were examined. Primary outcome measures were control of intraocular inflammation and tolerablity of the agents. Results: Forty–seven patients had received immunomodulatory therapy for a mean period of over 17 months and had a mean follow–up of 23.9 months (range 3–92 months). Indications included refractory disease, frequently relapsing disease, toxicty of corticosteroid or immunomodulatory agent and systemic disease. Inflammation was controlled in 35 pts (74.4%) (27 patients were still receiving the agents in the final follow–up and in 8 patients it was possible to discontinue the therapy). Out of 36 patients receiving chronic steroid therapy, it was possible reduce the dose of prednisone to below 15mg/day or discontinue altogether in 31 patients (86.1%). In 4 (8.5%) patients the drug had to be discontinued due to potential toxicity (suspected pneumonitis due to methotrexate in 2, liver function abnormality and GI intolerance in 1 and renal insufficiency due to cyclosporine in 1). However, none of these patients developed any permanent systemic morbidity on follow–up. Of the 41 patients' data available on pain, 30 had complete resolution of their pain and another 2 had minimal pain (total amounting to 78 %). Conclusions: Long–term immunomodulatory therapy appears to be effective and safe in the long–term control of refractory scleritis (about 75%). Side–effects are well tolerated and with careful clinical monitoring, potential toxicity can be minimized.
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