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Low-dose methotrexate therapy for ocular inflammatory disease.

S S Shah¹, C Y Lowder, M A Schmitt

¹Department of Ophthalmology, Cleveland Clinic Foundation, OH 44195-5024.

|September 1, 1992

Summary

Low-dose methotrexate effectively treats chronic ocular inflammation in patients resistant to steroids. This therapy reduces inflammatory activity and allows for corticosteroid tapering in many cases.

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Area of Science:

Ophthalmology
Rheumatology
Immunology

Background:

Methotrexate is a second-line anti-inflammatory drug for rheumatic diseases.
Low-dose methotrexate (12.5 mg/week) has a favorable safety profile.

Purpose of the Study:

To evaluate the efficacy of low-dose methotrexate in patients with chronic noninfectious ocular inflammatory diseases.
To assess methotrexate's utility in steroid-resistant or intolerant patients.

Main Methods:

Twenty-two patients with various ocular inflammatory conditions received weekly oral low-dose methotrexate.
Patient conditions included uveitis-vitreitis, scleritis, inflammatory pseudotumor, orbital myositis, and retinal vasculitis.

Main Results:

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Sixteen of 22 patients showed reduced inflammatory activity within a mean of 5 weeks.

Fourteen patients were able to reduce or stop corticosteroid use.

Five patients achieved complete disease remission; six showed no response.

Conclusions:

Low-dose methotrexate is a potentially effective treatment for ocular inflammatory diseases resistant to corticosteroids.
Methotrexate offers a viable alternative for patients who cannot tolerate or do not respond to standard therapies.