Efficacy of low-dose methotrexate for non-infectious uveitis and scleritis in the Japanese population

Abstract

Purpose : The use of methotrexate to control ocular inflammation is not common in Japan. This study elucidated the efficacy of methotrexate for non-infectious uveitis and scleritis in a Japanese population.

Methods : We performed a chart review of patients with non-infectious uveitis and scleritis who were treated with methotrexate at Hiroshima University from February 2016 to November 2016. Demographic and clinical characteristics, including the type of uveitis, dosage of methotrexate, control of inflammation after starting methotrexate, and corticosteroid-sparing effect were obtained. The reason for starting methotrexate, and incidence of and reason for discontinuation of therapy were also elucidated. Statistical significance was evaluated with the Wilcoxon signed-rank test.

Results : Seventeen patients were included. There were 8 males and mean age at start of therapy was 47.7±17.9 years (range, 16–68 years). Fourteen patients (82.4%) had non-infectious uveitis and 3 patients (17.6%) had scleritis. All patients had multiple episodes of recurrence of inflammation with reduced dose or stopping of topical or oral steroid. Four patients (23.6%) had elevated intraocular pressure or developed glaucoma and two (11.8%) had cataract formation during steroid therapy. After starting methotrexate therapy, three patients (17.6%) discontinued the therapy due to pancytopenia, fatigue, and elevated liver enzymes, respectively. The mean dose of methotrexate was 8.9 ± 3.3 mg/week (range, 6–16 mg). Among eight patients who had received oral prednisolone before methotrexate therapy and were followed more than 6 months after starting methotrexate, corticosteroid-sparing effect was obtained in all patients. Mean dose of prednisolone was decreased from 16.25 ± 6.4 mg/day to 5.5 ± 4.4 mg/day (P<0.01). No patient had deteriorated inflammation after staring therapy.

Conclusions : This study showed that methotrexate is effective for controlling ocular inflammation and is steroid-sparing in Japanese patients. The mean dose of methotrexate was lower than reported previously outside Japan^1,2. Lower-dose therapy may effectively control inflammation in the Japanese population.

References
1. Ophthalmology 2001; 108: 1134–1139
2. Br J Ophthalmol 2005; 89:806–808

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.