Uveitic patients tolerate methotrexate better than other immunosuppressants

Patients with uveitis and other inflammatory eye diseases tolerated methotrexate significantly longer than other steroid-sparing immunosuppressive agents, a study found.

Justine R. Smith, MBBS, PhD, and colleagues retrospectively compared the retention times of corticosteroid-sparing immunosuppressive drugs used by 107 patients with uveitis or other inflammatory eye diseases. Retention time, or how long a patient continues to take a medication, is a "crude indicator" of the tolerability and effectiveness of the drug in patients with chronic diseases, the study authors said.

The 107 patients used 12 types of corticosteroid-sparing systemic immunosuppressant for a total of 193 drug administrations.

Methotrexate was most commonly prescribed, with 66 drug uses (34%), and had the longest mean retention time of 1,216 days. Cyclosporine was second, with 37 uses (19%) and a more-than-twofold shorter mean retention time of 426 days (P = .004), according to the study authors.

Other commonly prescribed drugs were retained for significantly shorter durations, including azathioprine (P = .04), mycophenolate mofetil (P = .04) and cyclophosphamide (P = .001).

Overall, 98 of the 193 (51%) drug treatments were discontinued. Patients cited numerous reasons for drug discontinuation, including lack of efficacy, adverse events, treatment success or disease remission, poor compliance and cost.

A sub-analysis excluding patients who ceased treatment due to disease remission found similar results, with methotrexate continuing to show a more favorable retention rate, the authors noted.

"Despite a smaller sample size, all drugs were significantly less likely to be retained compared with methotrexate," they said.

The authors suggested that methotrexate may be better retained by patients due to its effectiveness, tolerability, relatively low cost and less frequent dosing regimen compared to other immunosuppressants.

The study is published in the December issue of the British Journal of Ophthalmology.