Methotrexate therapy for chronic noninfectious uveitis: Analysis of a case series of 160 patients

doi:10.1016/S0161-6420(01)00576-0

Ophthalmology

Volume 108, Issue 6, June 2001, Pages 1134-1139

Presented in part at the American Uveitis Society, October 25, 1999, during the American Academy of Ophthalmology annual meeting, Orlando, Florida.

https://doi.org/10.1016/S0161-6420(01)00576-0 Get rights and content

Abstract

Purpose

To evaluate the outcomes of patients with chronic noninfectious uveitis unresponsive to conventional antiinflammatory therapy who were treated with methotrexate.

Design

Retrospective noncomparative interventional case series.

Participants

All patients with chronic noninfectious uveitis treated with methotrexate at a single institution from 1985 to 1999.

Methods

Charts of patients seen on the Ocular Immunology & Uveitis Service at the Massachusetts Eye & Ear Infirmary were reviewed. Patients with chronic uveitis of noninfectious origin treated with methotrexate were included in the study.

Main outcome measures

Control of inflammation, steroid-sparing effect, visual acuity, adverse reactions.

Results

A total of 160 patients met the inclusion criteria. Control of inflammation was achieved in 76.2% of patients. Steroid-sparing effect was achieved in 56% of patients. Visual acuity was maintained or improved in 90% of patients. Side effects requiring discontinuation of medication occurred in 18% of patients. Potentially serious adverse reactions occurred in only 8.1% of patients. There was neither long-term morbidity nor mortality caused by methotrexate.

Conclusions

Methotrexate is effective in the treatment of chronic noninfectious uveitis that fails to respond to conventional steroid treatment. It is an effective steroid-sparing immunomodulator, is a safe medication, and is well tolerated.

Section snippets

Material and methods

The patients in this series were drawn from the total uveitis population seen on the Ocular Immunology & Uveitis Service at the Massachusetts Eye & Ear Infirmary between January 1985 and October 1999. The patients treated with MTX form the basis of this report. The Ocular Immunology & Uveitis Service is a tertiary referral service; most patients reported herein were referred by their primary ophthalmologists. Previous history and subsequent follow-up data were obtained through communications

Results

One hundred sixty patients in the chart review met the inclusion criteria. Seventy-four percent of the patients were female. The average age at onset of uveitis was 33 years. The average duration of uveitis before starting MTX was 5 years 3 months (median, 5 years), with a range from 4 months to 30 years. Mean duration of therapy was 14 months, with a range from 1 month to 96 months. Patients with follow-up times of 5 months or less consisted solely of those who experienced intolerance to the

Discussion

MTX was among the first nonsteroidal immunosuppressive medications used in the treatment of uveitis.4, 14, 15, 16, 17 Although it has been cited as an immunosuppressor agent for the treatment of uveitis and other ocular inflammatory disease since 1965, studies supporting its efficacy in ocular inflammatory disease are few.18, 19 This is in striking contrast to studies that strongly support the efficacy of MTX in the treatment of RA, including several randomized placebo-controlled trials.9, 10,

Acknowledgements

The authors acknowledge the assistance of Mr. Paul Chang and Ms. Fehma Tufail in obtaining follow-up data.

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Methotrexate therapy for chronic noninfectious uveitis: Analysis of a case series of 160 patients

Abstract

Purpose

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Section snippets

Material and methods

Results

Discussion

Acknowledgements

Rheum Dis Clin North Am

Ophthalmology

Ophthalmology

Am J Ophthlamol

Am J Ophthalmol

Am J Ophthalmol

Surv Ophthalmol

J Pediatr

Rheum Dis Clin North Am

Int J Immunopharmacol

Rheum Dis Clin North Am

Temporary remissions in acute leukemia in children produced by folic antagonist, 4-aminopteroyl-glutamic acid (aminopterin)

N Engl J Med

Therapeutic suppression of tissue reactivity. II. Effect of aminopterin in rheumatoid arthritis and psoriasis

Am J Med Sci

Methotrexate in the therapy of cyclitis

Trans Am Acad Ophthalmol Otolaryngol