Remission of Non-Infectious Anterior Scleritis: Incidence and Predictive Factors

• Published in: American journal of ophthalmology Vol. 223; pp. 377 - 395
• Main Authors: Kempen, John H., Pistilli, Maxwell, Begum, Hosne, Fitzgerald, Tonetta D., Liesegang, Teresa L., Payal, Abhishek, Zebardast, Nazlee, Bhatt, Nirali P., Foster, C. Stephen, Jabs, Douglas A., Levy-Clarke, Grace A., Nussenblatt, Robert B., Rosenbaum, James T., Sen, H. Nida, Suhler, Eric B., Thorne, Jennifer E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2021; Elsevier Limited
• Subjects: Adult; Cancer therapies; Clinical trials; Disease management; Drugs; Female; Follow-Up Studies; Humans; Immunosuppressive Agents - therapeutic use; Incidence; Inflammation; Inflammatory diseases; Male; Middle Aged; Population; Remission (Medicine); Remission Induction - methods; Retrospective Studies; Scleritis - drug therapy; Scleritis - epidemiology; Systemic diseases; United States - epidemiology; United States; United States > US; Massachusetts
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2019.03.024

To assess how often non-infectious anterior scleritis remits and identify predictive factors. Our retrospective cohort study at four ocular inflammation subspecialty centers collected data for each affected eye/patient at every visit from center inception (1978, 1978, 1984, 2005) until 2010. Remission was defined as inactivity of disease off all suppressive medications at all visits spanning at least three consecutive months or at all visits up to the last visit (to avoid censoring patients stopping follow-up after remission). Factors potentially predictive of remission were assessed using Cox regression models. During 1,906 years' aggregate follow-up of 832 affected eyes, remission occurred in 214 (170 of 584 patients). Median time-to-remission of scleritis = 7.8 years (95% confidence interval [CI]: 5.7, 9.5). More remissions occurred earlier than later during follow-up. Factors predictive of less scleritis remission included scleritis bilaterality (adjusted hazard ratio [aHR] = 0.46, 95% CI: 0.32-0.65); and diagnosis with any systemic inflammatory disease (aHR = 0.36, 95% CI: 0.23-0.58), or specifically with Rheumatoid Arthritis (aHR = 0.22), or Granulomatosis with Polyangiitis (aHR = 0.08). Statin treatment (aHR = 1.53, 95% CI: 1.03-2.26) within ≤90 days was associated with more remission incidence. Our results suggest scleritis remission occurs more slowly in anterior scleritis than in newly diagnosed anterior uveitis or chronic anterior uveitis, suggesting that attempts at tapering suppressive medications is warranted after long intervals of suppression. Remission is less frequently achieved when systemic inflammatory diseases are present. Confirmatory studies of whether adjunctive statin treatment truly can enhance scleritis remission (as suggested here) are needed.