Azathioprine for Ocular Inflammatory Diseases

Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA.
American Journal of Ophthalmology (Impact Factor: 3.87). 07/2009; 148(4):500-509.e2. DOI: 10.1016/j.ajo.2009.05.008
Source: PubMed


To evaluate treatment outcomes of azathioprine for noninfectious ocular inflammatory diseases.
Retrospective cohort study.
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.
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.
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.

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Available from: Jennifer E Thorne, Jan 16, 2014
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    • "This disease affects people of all ages, gender, and race, though sex preponderance can be observed in some cases [3] [4]. It also affects the working population between 20 and 59 years [5] [6]. Because of the variability of causes, the etiology of the uveitis is difficult to define. "
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    • "In all but two (Bialasiewicz et al, 1994; Pasadhika et al, 2009), AZA was used as steroid-sparring agent and the results were usually positive. There is a scarcity of data on AE of AZA for MMP, but according to a large study on ocular inflammatory diseases (Pasadhika et al, 2009), the drug was discontinued for AE at a rate of 0.16 per person-year (95% CI, 0.11–0.22). "
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    • "Leading the charge within ophthalmology are the anti-TNF therapies. We among others have undertaken a program of work which has investigated the role of TNF-α in the pathogenesis of uveitis [26], leading to the development of an anti-TNF-α fusion protein (TNFr-Ig) in 1996 which we evaluated first in an animal model of uveitis [27,28], and subsequently in a Phase II/proof of concept clinical trial in 2004 [4,29]. In this study, 71% of the patients achieved complete cessation of intraocular inflammation following TNFr-Ig therapy and a reduction in concomitant immunosuppression was possible in 65% of cases [29]. "
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