Azathioprine for Ocular Inflammatory Diseases

• Published in: American journal of ophthalmology Vol. 148; no. 4; pp. 500 - 509.e2
• Main Authors: Pasadhika, Sirichai, Kempen, John H, Newcomb, Craig W, Liesegang, Teresa L, Pujari, Siddharth S, Rosenbaum, James T, Thorne, Jennifer E, Foster, C. Stephen, Jabs, Douglas A, Levy-Clarke, Grace A, Nussenblatt, Robert B, Suhler, Eric B
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2009; Elsevier; Elsevier Limited
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Azathioprine - adverse effects; Azathioprine - therapeutic use; Biological and medical sciences; Child; Clinical trials; Confidence intervals; Deoxyribonucleic acid; Disease; DNA; Drug therapy; Eye diseases; Female; Follow-Up Studies; Health Insurance Portability & Accountability Act 1996-US; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Inflammation - drug therapy; Male; Medical sciences; Middle Aged; Miscellaneous; Ophthalmology; Pemphigoid, Benign Mucous Membrane - drug therapy; Prednisone - therapeutic use; Retrospective Studies; Scholarships & fellowships; Scleritis - drug therapy; Stock options; Success; Treatment Outcome; Uveitis - drug therapy; Young Adult; United States > US; Eye disease; Immunosuppressive agent; Ophthalmology; Azathioprine; Thiopurine derivatives; Inflammatory disease
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2009.05.008

Purpose To evaluate treatment outcomes of azathioprine for noninfectious ocular inflammatory diseases. Design Retrospective cohort study. Methods Medical records of 145 patients starting azathioprine as a sole noncorticosteroid immunosuppressant at 4 tertiary uveitis services were reviewed. Main outcome measures included control of ocular inflammation, sustained control after tapering prednisone to ≤ 10 mg/day, and discontinuation of treatment because of side effects. Results Among 145 patients (255 eyes) treated with azathioprine, 63% had uveitis, 23% had mucous membrane pemphigoid, 11% had scleritis, and 3% had other inflammatory diseases. By Kaplan-Meier analysis, 62% (95% confidence interval [CI], 50% to 74%) of patients with active disease initially gained complete inactivity of inflammation sustained over at least 28 days within 1 year of therapy, and 47% (95% CI, 37% to 58%) tapered systemic corticosteroids to ≤ 10 mg daily while maintaining control of inflammation within 1 year of therapy. Treatment success was most common for intermediate uveitis (90% with sustained inactivity within 1 year; 95% CI, 64% to 99%). Over the median follow-up of 230 days (interquartile range, 62 to 679 days), azathioprine was discontinued at a rate of 0.45 per person-years (/PY): 0.16/PY because of side effects, 0.10/PY because of ineffectiveness, 0.09/PY because of disease remission, and 0.10/PY because of unspecified causes. Conclusions Azathioprine was moderately effective as a single corticosteroid-sparing immunosuppressive agent in terms of control of inflammation and corticosteroid-sparing benefits, but required several months to achieve treatment goals; it seems especially useful for patients with intermediate uveitis. Treatment-limiting side effects occurred in approximately one-fourth of patients within 1 year, but typically were reversible.