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Discontinuous drug combination therapy in autoimmune ocular disorders
Author(s) -
Orsoni Jelka G.,
Zavota Laura,
Mora Paolo,
Rubino Pierangela,
Manzotti Francesca,
Pellistri Isabella
Publication year - 2009
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2008.01256.x
Subject(s) - medicine , visual acuity , immunosuppressive drug , drug , inflammation , prospective cohort study , corticosteroid , uric acid , steroid , surgery , pharmacology , transplantation , hormone
. Purpose: This study aimed to assess the effectiveness of a steroid‐sparing immunosuppressive treatment (IST) protocol in the control of severe or steroid‐resistant autoimmune ocular inflammatory diseases. Methods: We carried out a prospective, non‐randomized clinical study. Patients presenting with ocular inflammations that failed to respond adequately to steroids alone after monotherapy for a mean period of 9 ± 2 months (internal control) were offered the option to switch to a combined IST. The protocol consisted of different immunosuppressive drugs added in a stepladder sequence, where each drug (including the steroids) was administered discontinuously. Main outcome measures were control of inflammation, visual acuity and safety of treatment. Results: A total of 76 subjects (121 affected eyes) enrolled in the IST protocol. Mean length of follow‐up was 43 ± 15 months. Complete control of inflammation was achieved in 86% of patients. During the first year of IST, the rate of inflammatory recurrences/patient was 0.78 ± 1.13. This ratio diminished further during succeeding follow‐up. Mean best corrected visual acuity improved from 0.31 logMAR to 0.24 logMAR (p < 0.001). Blood pressure and uric acid blood levels significantly altered for the worse in the study group. Conclusions: Immunosuppressive treatment was effective in achieving inflammatory quiescence in a large majority of patients. The study also demonstrated the longterm safety of the protocol and its steroid‐sparing effect.