Cyclophosphamide for Ocular Inflammatory Diseases

Abstract

Purpose-To evaluate the outcomes of cyclophosphamide therapy for non-infectious ocular inflammation. Design-Retrospective cohort studyParticipants-Two hundred fifteen patients with non-infectious ocular inflammation observed from initiation of cyclophosphamide.Methods-Patients initiating cyclophosphamide, without other immunosuppressive drugs (other than corticosteroids), were identified at four centers. Dose of cyclophosphamide, response to therapy, corticosteroid-sparing effects, frequency of discontinuation and reasons for discontinuation were obtained by medical record review of every visit.Main Outcome Measures-Control of inflammation, corticosteroid-sparing effects, discontinuation of therapy. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptOphthalmology. Author manuscript; available in PMC 2011 February 1. Published in final edited form as:Ophthalmology. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptResults-The 215 patients (381 involved eyes) meeting eligibility criteria carried diagnoses of uveitis (20.4%), scleritis (22.3%), ocular mucous membrane pemphigoid (45.6%) or other forms of ocular inflammation (11.6%). Overall, approximately 49.2% (95% confidence interval (CI): 41.7%-57.2%) gained sustained control of inflammation (for at least 28 days) within 6 months, and 76% (95% CI: 68.3%-83.7%) within 12 months. Corticosteroid-sparing success (sustained control of inflammation while tapering prednisone to 10 mg or less among those not meeting success criteria initially) was gained by 30.0% and 61.2% by six and 12 months respectively. Disease remission leading to discontinuation of cyclophosphamide occurred at the rate of 0.32/person-year (95% CI: 0.24 -0.41), and the estimated proportion with remission at or prior to 2 years was 63.1% (95% CI: 51.5%-74.8%). Cyclophosphamide was discontinued by 33.5% of patients within one year because of side effects-usually of a reversible nature.Conclusions-Our data suggest that cyclophosphamide is effective for the majority of patients for controlling inflammation and allowing tapering of systemic corticosteroids to 10 mg of prednisone or less, although a year of therapy may be needed to achieve these goals. Unlike with most other immunosuppressive drugs, disease remission was induced by treatment in the majority of patients who were able to tolerate therapy. In order to titrate therapy properly and to minimize the risk of serious potential side effects, a systematic program of laboratory monitoring is required. Judicious use of cyclophosphamide appears bene...

Comparative study of ophthalmological and serological manifestations and the therapeutic response of patients with isolated scleritis and scleritis associated with systemic diseases

“…Patients with and without associated systemic disease were likely to require systemic therapy (94.4% and 100%, respectively), as related in recent literature (30) . During the therapeutic follow-up of IS patients, the medications used during a crisis were maintained, trying to reduce or even suspend at first the use of systemic corticoids, followed by the immunosuppressors (8,(31)(32)(33)(34) . For the treatment of SASD the aim is to change the initial treatment according to the underlying disease, and in some cases adequate treatment for the systemic disease already improves the ocular disease (4,35) .…”

Modern Opportunities in Uveitis Treatment

“…Gordon впервые при-менил кортикостероиды (ГКС) для лечения воспаления глаз, они заняли центральное место в лечении неинфек-ционных увеитов [22]. Их эффект обусловлен много-уровневым противовоспалительным действием -им-муносупрессивным, антиэкссудативным, противоаллер-гическим и антипролиферативным.…”

“…Стероидные препараты применяются в виде инстил-ляций, инъекций (субконъюктивально, парабульбарно, в субтеноново пространство, ретробульбарно, интра-витреально) и в качестве системной терапии [14,15,22,23]. Последние исследования показали эффективность использования в лечении неинфекционных задних уве-итов интравитреальных имплантов с постепенным вы-свобождением действующих веществ, содержащих дек-саметазон (Ozurdex) [23] или флюоцинолон ацетонид (Retisert) [24][25][26].…”

Corticosteroids and Anti-Complement Therapy in Retinal Diseases

“…This results in a cytotoxic effect, particularly of the rapidly proliferating cells of malignancy as well as T and B lymphocytes involved in inflammation (Pujari et al 2010). Thus, in addition to its use in chemotherapy, cyclophosphamide has also been utilized in the treatment of autoimmune diseases such as systemic lupus erythematosus and granulomatosis with polyarteritis (GPA, previously known as Wegener's granulomatosis) (Jabs et al 2000).…”