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  • Patients with birdshot chorioretinitis may not need steroids over the long term

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    Review of: Treatment outcomes in birdshot chorioretinitis: Corticosteroid sparing, corticosteroid discontinuation, remission, and relapse

    Crowell E, France R, Majumdar P, et al. Ophthalmology Retina, in press

    Studies have found that patients with birdshot chorioretinitis (BSCR) may need to be on oral corticosteroids for at least the first 2 years of treatment, despite the use of immunosuppressive therapies. Therefore, investigators evaluated the outcomes of BSCR treatment over the long term and determined rates of sustained drug-free remission as well as relapse.

    Study design

    This was a retrospective cohort study of 107 patients diagnosed with BSCR at 2 US-based tertiary academic centers between 2003 and 2017. Evaluated patient outcomes included corticosteroid-sparing success, ability to discontinue steroids, long-term drug-free remission, and relapse rates.

    Outcomes

    Successful steroid sparing was achieved in most patients, with 89.2% of patients discontinuing oral steroids by 48 months. However, based on the differences between the 2 centers studied, steroid sparing might be achievable as quickly as 6 months. Sustained drug-free remission was observed in 24.5% of patients at the 48-month follow-up visit; the relapse rate was 0.24/person-year, with a median time to relapse of 3.3 years. The most commonly used single agents were prednisone and mycophenolate mofetil; when 2 agents were used in combination, the most common second agent was a calcineurin inhibitor (e.g., cyclosporine, tacrolimus).

    Limitations

    The limitations of the study are its retrospective design, the 4.6-year duration of follow-up (which limits the ability to evaluate sustained drug-free remission), and the lack of a standardized approach to treating BSCR. There is significant variability among physicians in monitoring disease activity, corticosteroid tapering schedules, and the choice of a second agent or the indications to start a second agent.

    Clinical significance

    Results of this study indicate that with aggressive and early immunosuppressive medication management, patients with BSCR might be successfully weaned off corticosteroids as early as 6 months. This study is helpful in terms of prognosis for patients with a documented relapse rate and drug-free remission results.