Methotrexate as a first-line corticosteroid-sparing therapy in a cohort of uveitis and scleritis

Ocul Immunol Inflamm. 2003 Jun;11(2):131-9. doi: 10.1076/ocii.11.2.131.15919.

Abstract

Purpose: To evaluate the clinical experience with methotrexate as a first-line corticosteroid-sparing drug in patients with resistant ocular inflammation.

Methods: We retrospectively studied 39 consecutive patients with uveitis (n = 36) or scleritis (n = 3) who were treated with methotrexate following inadequate control with corticosteroids lasting five years. Criteria for initiating treatment with methotrexate and defining outcome were strictly defined.

Results: The cohort included 21 females and 18 males, all Caucasians, with a mean age of 26.6 years (range: 3-73 years). Patients were followed up for 21.5 +/- 12.6 months. Treatment was discontinued due to side effects in 10 patients (26%). Of the remaining 29 patients, full or partial control of inflammation was achieved in 23 (79%). Response to treatment was observed after a mean of 2.4 +/- 0.8 months. Ten patients were fully controlled and discontinued methotrexate therapy after a mean of 20.9 +/- 9.2 months, with no recurrence of inflammation. Use of topical and systemic corticosteroids was markedly reduced in responsive patients.

Conclusions: Methotrexate is recommended as a first-line adjunct to or replacement of systemic corticosteroids in the treatment of ocular inflammation.

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / administration & dosage*
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Male
  • Methotrexate / therapeutic use*
  • Middle Aged
  • Retrospective Studies
  • Scleritis / drug therapy*
  • Scleritis / physiopathology
  • Uveitis / drug therapy*
  • Uveitis / physiopathology
  • Visual Acuity

Substances

  • Adrenal Cortex Hormones
  • Immunosuppressive Agents
  • Methotrexate