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2014 ; 158
(6
): 1310-7
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Success with single-agent immunosuppression for multifocal choroidopathies
#MMPMID25194229
Goldberg NR
; Lyu T
; Moshier E
; Godbold J
; Jabs DA
Am J Ophthalmol
2014[Dec]; 158
(6
): 1310-7
PMID25194229
show ga
PURPOSE: To evaluate the success of single-agent immunosuppression for patients
with the posterior uveitides, birdshot chorioretinitis, multifocal choroiditis
with panuveitis, and punctate inner choroiditis. DESIGN: Retrospective case
series. METHODS: setting: Tertiary care uveitis practices. population: Patients
initiated on immunomodulatory therapy. intervention: Patients were treated with
prednisone 1 mg/kg and mycophenolate 2 g daily. Prednisone was tapered after 1
month. Immunosuppression was escalated to mycophenolate 3 g daily, with addition
of a second agent, as needed, to achieve treatment success. outcome measure:
Treatment success, defined as no disease activity with prednisone dose ?10 mg
daily, at 6, 12, and 24 months. RESULTS: Twenty-seven patients were followed.
Mean presentation and 2-year follow-up acuities were 20/41 and 20/42,
respectively. For birdshot chorioretinitis, mean (±standard deviation)
quantitative Goldmann visual field scores improved from 761 ± 69 degrees (IV/4
isopter) and 496 ± 115 degrees (I/4 isopter) at presentation to 784 ± 57 degrees
and 564 ± 125 degrees, respectively. Prednisone was successfully tapered in 95%
of patients; mean prednisone doses at 1 and 2 years were 5.3 ± 4.1 and 5.7 ± 4.8
mg/day, respectively. At 2 years, prednisone was discontinued in 11% of patients.
Treatment success was achieved in 74% of patients on 1 immunosuppressant, and in
an additional 21% of patients on 2 agents, for an overall 95% success rate at 2
years. CONCLUSIONS: Posterior uveitides can be treated with 1 agent in most
patients, but the data suggest a need to escalate therapy to higher mycophenolate
doses, and in one fifth of cases to add a second agent to maintain disease
suppression with acceptably low prednisone doses.
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