Use of corticosteroid sparing systemic immunosuppression for treatment of corticosteroid dependent optic neuritis not associated with demyelinating disease

Myers, Thomas D.; Smith, Justine R.; Wertheim, M. S.; Egan, Robert A.; Shults, William T.; Rosenbaum, James T.

doi:10.1136/bjo.2003.028472

Cited by 41 publications

(29 citation statements)

References 22 publications

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“…3,31,52,53 For neurosarcoidosis patients, treatment with methotrexate has been effective. 3,32 In one series, methotrexate was successful in controlling disease in 17 of 28 (61%) of cases.…”

Section: Management Of Neuro-ophthalmic Sarcoidosismentioning

confidence: 99%

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Neuro-ophthalmic sarcoidosis

Baughman¹,

Weiss²,

Golnik³

2012

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Neuro-ophthalmic disease occurs in about a third of patients with neurosarcoidosis. Optic nerve involvement is the most common manifestation, but other cranial nerves and the optic chiasm can be involved. However, there are several other common diseases that cause optic neuropathy, including multiple sclerosis. The diagnosis of sarcoidosis can often be made based on the multi-organ nature of the disease and ancillary testing. Most patients with neuro-ophthalmic sarcoidosis require systemic therapy. While corticosteroids are usually the first step in therapy, cytotoxic agents such as methotrexate and azathioprine have been useful as steroid-sparing agents for chronic disease. The monoclonal antibodies directed against tumor necrosis factor have been reported as effective in refractory cases of neuro-ophthalmic disease.

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Section: Management Of Neuro-ophthalmic Sarcoidosismentioning

confidence: 99%

“…Therefore steroid sparing alternatives are often employed. 31,52 Our approach is to add a cytotoxic agent early in treatment unless the patient is highly responsive to initial corticosteroids.…”

Section: Management Of Neuro-ophthalmic Sarcoidosismentioning

confidence: 99%

Neuro-ophthalmic sarcoidosis

Baughman¹,

Weiss²,

Golnik³

2012

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“…Among immunosuppressant agents, therapeutic evidence of methotrexate has been accumulated based on several studies. Methotrexate is reported to be therapeutically effective primarily in cases of skin lesions (17,18), ocular lesions (19) and neuromuscular lesions (20). In our clinical experience, the agent is therapeutically effective, albeit incompletely, for chronic sarcoidosis involving lesions of the lungs, heart and neuromuscular system.…”

Section: Discussionmentioning

confidence: 98%

Treatment with Methotrexate and Low-dose Corticosteroids in Sarcoidosis Patients with Cardiac Lesions

Nagai¹,

Yokomatsu

Tanizawa

et al. 2014

Intern. Med.

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Objective Our objective was to evaluate the effectiveness of combination therapy consisting of low-dose corticosteroids with weekly methotrexate in patients with cardiac sarcoidosis in whom long-term therapy is required. Combination therapy was selected because long-term standard corticosteroid therapy tends to result in various adverse effects and the steroid-sparing effects of methotrexate have been reported. Methods This study was a small open-label study comparing long-term functional changes between patients who received combination therapy (5-15 mg/day of prednisolone and 6 mg/week of methotrexate) and patients who received corticosteroids alone. The comparative analysis was based on the following therapeutic indexes: ejection fraction (EF), left ventricular end-diastolic diameter (LVDd) on echocardiography, serum Nterminal fragment pro-brain natriuretic peptide (NT-proBNP) and cardiothoracic ratio (CTR) on plain chest radiographs. Patients Seventeen patients with cardiac sarcoidosis were examined in the sarcoidosis clinic. Cardiac sarcoidosis was diagnosed based on the Japanese diagnostic guidelines published in 2006. Results The EF was significantly stabilized in the combination therapy group but not in the corticosteroids alone group at three years after the first treatment. The CTR and NT-proBNP levels were significantly stabilized in the combination therapy group compared with those observed in the corticosteroids alone group at both three and five years after the first treatment. The LVDd values tended to be stable in the combination therapy group compared with those observed in the corticosteroids alone group. The combination therapy was associated with few adverse effects. Conclusion Weekly methotrexate therapy with daily small doses of corticosteroids stabilized the EF, CTR and NT-proBNP levels in the serum without eliciting adverse effects longitudinally.

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“…Systemic immunosuppression with methotrexate and azathioprine may be a safer and more effective treatment alternative to chronic oral corticosteroid use in cases of corticosteroid dependent optic neuritis not associated with demyelinating disease. 16 Chronic Relapsing Inflammatory Optic Neuropathy (CRION) was described by Kidd et al with a median followup of 8 years and in no case there was evidence for systemic sarcoidosis, tuberculosis or any other granulomatous inflammation. 17 Most patients retained good-to-excellent vision more than 10 years after an attack of optic neuritis in many studies.…”

Section: Discussionmentioning

confidence: 99%

Isolated Visual Loss and Neurological Causes: A Hospital-Based Study

G¹,

Reddy²,

R³

et al. 2016

jemds

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Visual loss is a common presenting symptom in the Outpatient Departments of Neurology, Ophthalmology and General Medicine disciplines. The present prospective study aims at evaluating 48 patients with partial or total visual loss as the predominant or only presenting symptom and with no associated ocular problems like cataract, glaucoma or diabetic retinopathy. The neurological causes were identified, analysed and tabulated; 39% of patients were below 20 years of age and there was 3:2 ratio of female versus male prevalence. Nearly 66% had acute visual loss and 35% had chronic visual loss. Majority of patients (48%) had profound visual loss limited to finger counting; 6% had normal visual acuity associated with field defects. The visual evoked potentials were abnormal in all cases with acute and sub-acute presentation and in some patients with sudden or chronic presentation also. The VEP abnormalities consisted of prolonged P100 latencies, loss of amplitudes or poor wave morphology. Cranial CT scan was done in 36 patients and was abnormal in 83% patients. It showed intracranial tumours in 8% patients and infarcts in another 8% patients. Cranial MRI scan was done in 12 patients and was normal in 83% patients. The aetiological considerations and treatment protocols followed are discussed. The limitations of such study in the present setup are also highlighted.

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Use of corticosteroid sparing systemic immunosuppression for treatment of corticosteroid dependent optic neuritis not associated with demyelinating disease

Cited by 41 publications

References 22 publications

Neuro-ophthalmic sarcoidosis

Neuro-ophthalmic sarcoidosis

Treatment with Methotrexate and Low-dose Corticosteroids in Sarcoidosis Patients with Cardiac Lesions

Isolated Visual Loss and Neurological Causes: A Hospital-Based Study

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