Original articleCyclophosphamide for Ocular Inflammatory Diseases
Section snippets
Study Population
The Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study is a multicenter cohort study for identifying long-term treatment adverse events, the methods of which have been described previously.33 For this report, all patients at 3 academic subspecialty centers with noninfectious ocular inflammation since the inception of the center and an approximate 40% random sample of such patients from a fourth center potentially were eligible. Sampling was carried out because of logistical
Results
Two hundred fifteen patients (77.2% with bilateral ocular inflammation; 381 eyes) were identified who started cyclophosphamide as a single immunosuppressive agent during follow-up, with or without local or systemic corticosteroids and nonsteroidal anti-inflammatory drugs. The demographic and clinical characteristics of this cohort are summarized in Table 1. The overall median age was 61.3 years (range, 11.5–91.4 years). Most patients were white (83.3%) and female (58.1%). The patients with
Discussion
This report confirms the beneficial effects of cyclophosphamide therapy for ocular inflammation. Cyclophosphamide was successful in achieving complete control of inflammation in 49.2% and 76.3% by 6 months and 12 months, respectively. Similarly, corticosteroid-sparing success (sustained control of inflammation while tapering prednisone to 10 mg or less) was gained by 30.1% and 61.2% by 6 and 12 months, respectively. At or before 2 years after initiation of treatment, 63% were able to
References (65)
- et al.
The use of ACTH and cortisone in ophthalmology
Am J Ophthalmol
(1951) - et al.
Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel
Am J Ophthalmol
(2000) - et al.
Immunosuppressive drugs in immune and inflammatory ocular disease
Surv Ophthalmol
(1991) - et al.
Extra-articular manifestations and complications of rheumatoid arthritis
Best Pract Res Clin Rheumatol
(2007) - et al.
Microscopic polyangiitis [in French]
Presse Med
(2007) Treatment of systemic lupus erythematosus in 2006
Joint Bone Spine
(2006)- et al.
The effect of treatment and its related side effects in patients with severe ocular cicatricial pemphigoid
Ophthalmology
(2002) - et al.
Severe Moorens ulcer: efficacy of monthly cyclophosphamide intravenous pulse treatment [in French]
Rev Med Interne
(2003) - et al.
Vogt-Koyanagi-Harada syndrome
Surv Ophthalmol
(1995) - et al.
Diagnostic and therapeutic management of Vogt-Koyanagi-Harada syndrome [in French]
J Fr Ophtalmol
(2005)
Immunosuppressive therapy in ocular cicatricial pemphigoid
Am J Ophthalmol
Pulse IV cyclophosphamide in ocular inflammatory disease: efficacy and short-term safety
Ophthalmology
Therapy of scleritis with cytotoxic agents
Am J Ophthalmol
Ocular presentation of polyarteritis nodosa: clinical course and management with steroid and cytotoxic therapy
Ophthalmology
Mortality rate in rheumatoid arthritis patients developing necrotizing scleritis or peripheral ulcerative keratitis: effects of systemic immunosuppression
Ophthalmology
Sterility and testicular atrophy related to cyclophosphamide therapy
Lancet
Ocular toxicity of antineoplastic agents
Ophthalmology
Malignancy following treatment of rheumatoid arthritis with cyclophosphamide: long-term case-control follow-up study
Am J Med
Treatment of uveitis: overview
Nitrogen mustard therapy of uveitis of unknown etiology [undetermined language]
Rev Clin Esp
Immunosuppressive drugs
Treatment of patients with Wegener's granulomatosis or ANCA-associated vasculitis [in Dutch]
Ned Tijdschr Geneeskd
Wegener's granulomatosis
Curr Opin Rheumatol
Ocular manifestations of Wegener's granulomatosis: analysis of nine cases
Indian J Ophthalmol
Diagnosis and management of systemic Wegener's granulomatosis presenting with anterior ocular inflammatory disease
Br J Ophthalmol
Ocular involvement in Wegener's granulomatosis responding to intravenous cyclophosphamide [letter]
Rheumatology (Oxford)
Wegener's granulomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years
Ann Intern Med
Influence of disease manifestation and antineutrophil cytoplasmic antibody titer on the response to pulse cyclophosphamide therapy in patients with Wegener's granulomatosis
Arthritis Rheum
Diagnosis and therapy of Wegener's granulomatosis based on ocular changes [in Czech]
Cesk Slov Oftalmol
Disease-modifying antirheumatic drugs: using their clinical pharmacological effects as a guide to their selection
Drugs
Polyarteritis nodosa revisited
Curr Rheumatol Rep
New concepts for the therapy of systemic lupus erythematosus [in French]
Rev Med Suisse
Cited by (135)
Chronic inflammation and cancer; the two sides of a coin
2024, Life SciencesScleritis and episcleritis
2023, Revue de Medecine InterneOcular involvement in autoimmune bullous diseases
2023, Clinics in DermatologyTolerance and efficacy of anti-TNF currently used for severe non-infectious uveitis
2021, Autoimmunity ReviewsRemission of Non-Infectious Anterior Scleritis: Incidence and Predictive Factors
2021, American Journal of OphthalmologyBeyond the joints, the extra-articular manifestations in rheumatoid arthritis
2021, Autoimmunity Reviews
Manuscript no. 2009-399.
Financial Disclosure(s): The author(s) have made the following disclosure(s):
C. Stephen Foster - Equity Owner - Eyegate; Consultant, Lecturer - Allergan, Bausch & Lomb; Consultant - Sirion; Lecturer - Alcon, Inspire, Ista, Centocor
Douglas A. Jabs - Consultant - Roche, Genzyme Corporation, Novartis, Allergan, Glaxo Smith Kline, Applied Genetic Technologies Corporation, The Emmes Corporation, The Johns Hopkins Dana Center for Preventive Ophthalmology
John H. Kempen - Consultant - Lux Biosciences
James Rosenbaum - Equity Owner - Amgen; Consultant - Abbott, ESBATech, Lux Biosciences, Centocor, Genentech
Supported primarily by the National Eye Institute, Bethesda, Maryland (grant no.: EY014943 [JHK]). Additional support was provided by Research to Prevent Blindness, Inc., New York, New York, and the Paul and Evanina Mackall Foundation, New York, NY. Dr Kempen is a Research to Prevent Blindness James S. Adams Special Scholar Award recipient. Drs. Jabs and Rosenbaum are Research to Prevent Blindness Senior Scientific Investigator Award recipients. Dr. Thorne is a Research to Prevent Blindness Harrington Special Scholar Award recipient. Dr Levy-Clarke previously was supported by and Dr. Nussenblatt continues to be supported by intramural funds of the National Eye Institute. Dr Suhler also received support from the Veterans' Administration, Washington, DC. None of the sponsors had any role in the design and conduct of the report; collection, management, analysis, and interpretation of the data; nor in the preparation, review, and approval of this manuscript.