June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
How long are adult patients with inflammatory eye disease maintained on systemic immunosuppression?
Author Affiliations & Notes
  • Matthew Azzopardi
    Birmingham and Midland Eye Centre, Birmingham, Birmingham, United Kingdom
    Academic Unit of Ophthalmology, University of Birmingham Institute of Inflammation and Ageing, Birmingham, West Midlands, United Kingdom
  • Yu Jeat Chong
    Birmingham and Midland Eye Centre, Birmingham, Birmingham, United Kingdom
  • Sreekanth Sreekantam
    Birmingham and Midland Eye Centre, Birmingham, Birmingham, United Kingdom
  • Robert J. Barry
    Birmingham and Midland Eye Centre, Birmingham, Birmingham, United Kingdom
    Academic Unit of Ophthalmology, University of Birmingham Institute of Inflammation and Ageing, Birmingham, West Midlands, United Kingdom
  • Natraj Poonit
    Birmingham and Midland Eye Centre, Birmingham, Birmingham, United Kingdom
  • Saaeha Rauz
    Birmingham and Midland Eye Centre, Birmingham, Birmingham, United Kingdom
    Academic Unit of Ophthalmology, University of Birmingham Institute of Inflammation and Ageing, Birmingham, West Midlands, United Kingdom
  • Philip Ian Murray
    Birmingham and Midland Eye Centre, Birmingham, Birmingham, United Kingdom
    Academic Unit of Ophthalmology, University of Birmingham Institute of Inflammation and Ageing, Birmingham, West Midlands, United Kingdom
  • Footnotes
    Commercial Relationships   Matthew Azzopardi None; Yu Jeat Chong None; Sreekanth Sreekantam None; Robert Barry None; Natraj Poonit None; Saaeha Rauz None; Philip Murray None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 3549. doi:
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      Matthew Azzopardi, Yu Jeat Chong, Sreekanth Sreekantam, Robert J. Barry, Natraj Poonit, Saaeha Rauz, Philip Ian Murray; How long are adult patients with inflammatory eye disease maintained on systemic immunosuppression?. Invest. Ophthalmol. Vis. Sci. 2023;64(8):3549.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : We wished to determine how long our patients with non-infectious, sight-threatening inflammatory eye disease (IED) are maintained on systemic immunosuppression whilst in clinical remission, as there are no consensus guidelines for treatment withdrawal, although two years in disease remission has been recommended for uveitis patients. We hope these data will allow us to better inform our patients and provide a framework to develop formal guidelines of when it might be safe to withdraw treatment.

Methods : Data from adult IED patients on systemic immunosuppression were entered into a REDCap® database. Four disease groups were identified: Ocular Surface Disease (OSD), Scleritis, Corneal Transplant Survival Strategies (CTSS) and Uveitis. Details regarding type of immunosuppressants and biologics used; duration of treatment; reasons for discontinuing, changing, or adding another medication; whether the ocular disease is in remission and if so, for how long, were captured.

Results : Out of a total of 303 IED patients, 82 were no longer on treatment. There were 133/221 (60%) patients on systemic immunosuppression who were deemed to be in remission of their ocular disease for ≥24 months. Of these 133 patients, 5 still required ongoing treatment for an underlying associated systemic disease, leaving 128 patients. The commonest immunosuppressants and biologics used throughout the course of therapy were mycophenolate mofetil 69.0%, methotrexate 30.7%, azathioprine 25.7%, adalimumab 14.2%, and infliximab 5.0%.

Conclusions : Mean duration of treatment for IED patients who are in remission for ≥24 months was almost 6 years with some patients on treatment 9-22 years, depending on their diagnosis. As certain types of progressive OSD may require lifelong immunosuppression, we recommend that uveitis patients who have been in remission for at least 18 months are considered for immunosuppression withdrawal if they remain in remission for two years.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Abbreviations: OSD, Ocular Surface Disease; CTSS, Corneal Transplant Survival Strategies

Abbreviations: OSD, Ocular Surface Disease; CTSS, Corneal Transplant Survival Strategies

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