Abstract
Purpose :
Uveitis is the third leading cause of blindness in the U.S. with over 35,000 new patients diagnosed each year. Immunomodulatory therapy (IMT) such as mycophenolate and methotrexate (MTX) has been used safely for the last two decades but practice patterns differ and there is a paucity of data on the length of drug-free remission obtained after discontinuation of these medications.
Methods :
A retrospective, observational clinical study was performed identifying 26 patients seen at the Manhattan Eye, Ear & Throat Hospital Uveitis Department between 2017 and 2018. All patients were previously treated with either MMF or MTX with an average of ten year follow-up after cessation of IMT, with a minimum of five years. This is the longest follow-up period after IMT cessation of any prior studies.
Results :
22 patients (84.62%) successfully maintained remission after discontinuation of IMT with an average follow up of 10.38 years since discontinuation. Of these 22 patients, 11 required no further steroid drops during the follow up period, 5 were maintained on chronic steroid drops, and 6 were successfully treated with steroid drops for acute episodes. 4 patients (15.38%) underwent relapse eventually requiring restarting IMT. Relapse occurred in these patients after an average of 9.63 years of being in remission. For all 26 patients, average duration of treatment with IMT was 3.38 years. No trend was noted regarding duration of treatment and duration of remission.
Conclusions :
After a limited duration of treatment with MMF or MTX for uveitis, a majority of patients were able to achieve remission of their disease during the ten year follow-up period. This information is useful for ophthalmologists and patients to understand and quantify the long term benefits of treating uveitis with IMT. Future research will help us identify which patients are more likely to relapse and/or which patients may require longer treatment with IMT.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.