Tacrolimus(TAC) In The Treatment Of Birdshot Retinochoroidopathy(BRC): Safety Profile and Efficacy

Abstract

Purpose : BRC is an uncommon,chronic idiopathic posterior uveitis requiring long term immunosuppression.Cyclosporine(CY) has been conventionally used for long term immunosuppression agents(ISA) since it is thought to be secondary to T-cell mediated responses,but CY has many side effects including nephrotoxicity and renal impairment.We evaluated the safety and outcome of treatment with TAC.

Methods : We studied retrospectively the medical records of 25 patients diagnosed with BRC treated with TAC at Moorfields Eye Hospital,who were refractory to or intolerant to oral steroids and other ISA.The main outcome measures were tolerability of TAC while on treatment, its effects on renal profile, changes in visual field and Electrodiagnostics(EDD) parameters over at least six months and overall control of inflammation and visual stability.

Results : We identified 25 patients, 20 females (80%). Mean age was 50.4±10.8(Range 32-86) years.Mean follow-up was 1.49± 2.07(Range 0.01-10) years.Nine patients(36%) were on high dose steroid taper and 16 patients(64%) were active despite the use of other ISAs,when TAC was started.Twenty one patients(84%) tolerated TAC well, in 4 patients TAC had to be stopped:1 due to intolerance because of Gastrointestinal upset,1 due to hypertension,1 due to insomnia and 1 due to shortness of breath.Two patients(8%) required increased dose of anti hypertensive treatment and 3(12%) required increased dose of anti-hypercholesterolemic medication.At the end of month 1, 3 patients(12%) showed slight (<30%) derangement in renal function, at month 3, 1 patient (4%). At month 6 only 1 patient slight derangement in renal function (mainly creatinine levels).Mean number of flare-ups during the follow-up period was 0.45±0.739. Mean time taken to taper steroids to < 10mg after starting TAC was 0.07±0.20 years.The visual acuity remained stable in all except 1 patient. Visual fields improved over time (mean improvement in Humphrey MD, RE=1.8 ±2.4dB t=-3.821 p=0.004, LE=-1.9 ±2.7dB t=-3.06 p=0.007.The difference between daily oral steroid dose at the start of TAC and at last follow-up was statistically significant(mean Prednisolone dose at start 19.7 mg vs 6.9 mg at end, t=5.071 p=0.001).Illustrative EDD will be presented.

Conclusions : TAC has a good safety profile for long term use in BRC patients as a second line agent. It enabled steroid sparing and achieved visual stabilization over the study period.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.