Immunosuppressive Drug Discontinuation in Noninfectious Uveitis
American Journal of Ophthalmology, September 2016
To assess the rate of nonsteroidal immunosuppressive drug (ISD) discontinuation among uveitis patients in real-life clinical practice, Abásolo et al. carried out a longitudinal retrospective cohort study at a tertiary-care eye center in Madrid. Looking at both biologic and nonbiologic agents, the researchers found that the leading cause for discontinuation was clinical efficacy (i.e., achievement of disease control), followed by inefficacy and adverse reactions.
This study included 110 patients with 263 treatment courses and 665.2 patient-years of observation between 1989 and 2015. Cyclosporine (66.4%), methotrexate (47.3%), azathioprine (30.9%), and anti–tumor necrosis factor biologic agents (anti-TNFs; 30.9%) were the most frequently used ISDs; both monotherapy and combination regimens were used.
The main outcome variable was all ISD discontinuations owing to 1) inefficacy (the physician’s judgment that the treatment failed to improve inflammation or that relapses occurred); 2) clinical efficacy (the physician’s judgment that the treatment could be discontinued because inflammation was controlled); 3) adverse drug reactions (ADRs); and 4) other causes (including pregnancy, patient decision, change of diagnosis, and elective surgeries). The authors also analyzed covariates including patient demographics and location and characteristics of the uveitis.
Of the 263 treatment courses, 136 were discontinued for the following reasons: clinical efficacy (38.2%), inefficacy (26.5%), ADRs (22.8%), and other causes (12.5%). The most frequent ADRs were digestive (mostly gastrointestinal intolerance), increase of liver enzymes, deterioration of renal function, and infections.
The authors found that combined therapy (with or without biologic drugs) was associated with higher discontinuation rates due to clinical efficacy when compared with monotherapy with nonbiologic ISDs. In contrast, combined therapy of azathioprine with other nonbiologic drugs appeared to have a higher risk of discontinuation due to ADRs. The authors concluded that, based on these results, caution and close monitoring should be used with patients receiving nonbiologic drugs in combination with azathioprine in the treatment of noninfectious uveitis.
The original article can be found here.