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Azathioprine for ocular inflammatory diseases
Sirichai Pasadhika1, John H Kempen, Craig W Newcomb
1Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA.
American Journal of Ophthalmology
|July 3, 2009
Summary
Azathioprine showed moderate effectiveness in controlling noninfectious ocular inflammation and reducing corticosteroid use. While achieving treatment goals took months, it proved particularly beneficial for intermediate uveitis, with reversible side effects in about a quarter of patients.
Area of Science:
- Ophthalmology
- Immunosuppressive Therapy
- Autoimmune Diseases
Background:
- Noninfectious ocular inflammatory diseases require effective immunosuppressive therapy.
- Corticosteroids are often used but associated with significant side effects.
- Steroid-sparing agents are crucial for long-term management.
Purpose of the Study:
- To evaluate the effectiveness of azathioprine as a sole noncorticosteroid immunosuppressant.
- To assess treatment outcomes including inflammation control and corticosteroid tapering.
- To determine the rate and reasons for azathioprine discontinuation.
Main Methods:
- Retrospective cohort study of 145 patients with noninfectious ocular inflammatory diseases.
- Azathioprine initiated as the only non-corticosteroid immunosuppressant.
- Outcomes measured: inflammation control, sustained control after prednisone tapering, and treatment discontinuation due to side effects.
Main Results:
- 62% of patients achieved sustained inflammation inactivity within 1 year.
- 47% successfully tapered systemic corticosteroids to ≤10 mg/day.
- Treatment success was highest in intermediate uveitis (90%).
- Azathioprine was discontinued in 0.45/person-years, with 0.16/PY due to side effects.
Conclusions:
- Azathioprine is a moderately effective corticosteroid-sparing agent for noninfectious ocular inflammation.
- It requires several months to achieve therapeutic goals.
- Particularly effective for intermediate uveitis.
- Approximately one-fourth of patients experienced reversible, treatment-limiting side effects within a year.
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