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Systemic drug toxicity trends in immunosuppressive therapy of immune and inflammatory ocular disease
R R Tamesis1, A Rodriguez, W G Christen
1Department of Ophthalmology, University of Nebraska Medical Center, Omaha, USA.
Purpose:
To compare the relative toxicities of six systemic immunosuppressive drugs and systemic corticosteroids used to treat patients with severe ocular inflammatory disease and to identify factors influencing their occurrence.
Methods:
The authors reviewed the clinical records of 602 patients with ocular inflammatory disease treated with immunosuppressive drug therapy and/or systemic corticosteroids for adverse systemic effects while undergoing therapy. Proportional hazards regression analysis was performed to identify demographic and clinical factors that influence the occurrence of drug toxicity in these patients.
Results:
Immunosuppressive drug treatment was more likely to result in discontinuation of therapy because of toxic side effects than was corticosteroid treatment. However, unlike many of the side effects of corticosteroid treatment, the side effects of immunosuppressive therapy were reversible with reduction in dosage or discontinuation of the drug. Gastrointestinal symptoms and hematologic abnormalities accounted for the majority of reported side effects of the immunosuppressive medications. Neuro-psychiatric and endocrine side effects were common in patients taking prednisone. In 17 patients treated with prednisone, pathologic fractures developed, which involved the hips and the spine. Female sex and age older than 60 years also were identified as factors associated with intolerance to drug therapy in the authors' study population. Race and type of systemic ocular disease were not significant factors influencing tolerance to drug therapy.
Conclusion:
These findings suggest that when properly administered and monitored for adverse effects, most immunosuppressive agents used in the current study have similar risk profiles with relatively few serious therapeutic mishaps and largely reversible side effects. In contrast, corticosteroids can result in permanent disabilities as a result of long-term treatment.
Insights
Systemic corticosteroids pose a higher risk of permanent disability compared to immunosuppressive drugs for severe ocular inflammatory disease. While immunosuppressive drugs may cause reversible side effects, corticosteroids can lead to lasting harm.
Area of Science:
- Ophthalmology
- Pharmacology
- Immunology
Background:
- Severe ocular inflammatory diseases require systemic immunosuppressive therapy.
- Systemic corticosteroids are commonly used but associated with significant side effects.
- Comparing toxicities of different immunosuppressive agents is crucial for patient management.
Purpose of the Study:
- To compare the toxicities of six systemic immunosuppressive drugs and systemic corticosteroids.
- To identify factors influencing the occurrence of drug toxicity in patients with ocular inflammatory disease.
Main Methods:
- Retrospective review of 602 patients with ocular inflammatory disease.
- Analysis of adverse systemic effects during immunosuppressive drug therapy and/or corticosteroid treatment.
- Proportional hazards regression analysis to identify demographic and clinical factors associated with drug toxicity.
Main Results:
- Immunosuppressive drug therapy led to more frequent discontinuation due to toxicity than corticosteroid therapy.
- Side effects of immunosuppressive therapy were generally reversible, unlike corticosteroid-induced side effects.
- Gastrointestinal and hematologic issues were common with immunosuppressants; neuropsychiatric and endocrine effects, including fractures, occurred with prednisone. Female sex and age over 60 were linked to intolerance.
Conclusions:
- Most immunosuppressive agents have similar, largely reversible risk profiles when properly monitored.
- Corticosteroids, particularly with long-term use, can cause permanent disabilities.
- Careful administration and monitoring are essential for managing drug toxicity in ocular inflammatory diseases.