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Am J Ophthalmol. 2014 Dec;158(6):1310-7. doi: 10.1016/j.ajo.2014.08.039. Epub 2014 Sep 3.

Success with single-agent immunosuppression for multifocal choroidopathies.

Author information

1
Department of Ophthalmology, The Icahn School of Medicine at Mount Sinai, New York, New York.
2
Department of Biostatistics, The Icahn School of Medicine at Mount Sinai, New York, New York; Institute for Translational Epidemiology, The Icahn School of Medicine at Mount Sinai, New York, New York.
3
Department of Ophthalmology, The Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York; Institute for Translational Epidemiology, The Icahn School of Medicine at Mount Sinai, New York, New York; Center for Clinical Trials, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: douglas.jabs@mssm.edu.

Abstract

PURPOSE:

To evaluate the success of single-agent immunosuppression for patients with the posterior uveitides, birdshot chorioretinitis, multifocal choroiditis with panuveitis, and punctate inner choroiditis.

DESIGN:

Retrospective case series.

METHODS:

setting: Tertiary care uveitis practices. population: Patients initiated on immunomodulatory therapy. intervention: Patients were treated with prednisone 1 mg/kg and mycophenolate 2 g daily. Prednisone was tapered after 1 month. Immunosuppression was escalated to mycophenolate 3 g daily, with addition of a second agent, as needed, to achieve treatment success. outcome measure: Treatment success, defined as no disease activity with prednisone dose ≤10 mg daily, at 6, 12, and 24 months.

RESULTS:

Twenty-seven patients were followed. Mean presentation and 2-year follow-up acuities were 20/41 and 20/42, respectively. For birdshot chorioretinitis, mean (±standard deviation) quantitative Goldmann visual field scores improved from 761 ± 69 degrees (IV/4 isopter) and 496 ± 115 degrees (I/4 isopter) at presentation to 784 ± 57 degrees and 564 ± 125 degrees, respectively. Prednisone was successfully tapered in 95% of patients; mean prednisone doses at 1 and 2 years were 5.3 ± 4.1 and 5.7 ± 4.8 mg/day, respectively. At 2 years, prednisone was discontinued in 11% of patients. Treatment success was achieved in 74% of patients on 1 immunosuppressant, and in an additional 21% of patients on 2 agents, for an overall 95% success rate at 2 years.

CONCLUSIONS:

Posterior uveitides can be treated with 1 agent in most patients, but the data suggest a need to escalate therapy to higher mycophenolate doses, and in one fifth of cases to add a second agent to maintain disease suppression with acceptably low prednisone doses.

PMID:
25194229
PMCID:
PMC4254288
DOI:
10.1016/j.ajo.2014.08.039
[Indexed for MEDLINE]
Free PMC Article

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