Retrospective review of methotrexate therapy in the treatment of chronic, noninfectious, nonnecrotizing scleritis.

PURPOSE: To determine the effectiveness and steroid-sparing capabilities of methotrexate in the treatment of chronic, noninfectious, nonnecrotizing scleritis. DESIGN: Retrospective chart review. METHODS: We conducted a retrospective chart review of all patients treated for scleritis between January 1, 2000 and July 31, 2005 at the Institute of Ophthalmology and Visual Science at New Jersey Medical School of the University of Medicine and Dentistry of New Jersey. Outcome measures included inflammation, corticosteroid and methotrexate dosages, visual acuity, and reported side effects. RESULTS: Eighteen patients, with a total of 27 affected eyes, were included in the study: 15 women and three men with a mean age of 52 years. Inflammation control was achieved in 11 patients, nine women and two men. Successful corticosteroid sparing was achieved in 10 of the 11 patients, with three patients completely discontinuing corticosteroid use. Visual acuity was maintained or improved in 21 (78%) of 27 affected eyes. Eight patients reported adverse effects, with one patient discontinuing treatment because of unbearable fatigue. The dose of methotrexate ranged from 7.5 to 35 mg weekly. The mean duration of methotrexate therapy was 19 months (standard deviation, 11 months). There were no serious adverse reactions or long-term morbidity caused by methotrexate therapy. CONCLUSIONS: Methotrexate seems to be a well-tolerated therapy that can reduce inflammation successfully and can decrease the corticosteroid requirement in the treatment of chronic, noninfectious, and nonnecrotizing scleritis.

Mycophenolate mofetil in the treatment of chronic non-infectious, non-necrotizing scleritis.

PURPOSE: To determine the effectiveness and corticosteroid (CS) sparing capabilities of mycophenolate mofetil (MMF) in the treatment of chronic non-infectious, non-necrotizing scleritis. METHODS: A retrospective chart review of patients treated for scleritis at the Institute of Ophthalmology and Visual Science at New Jersey Medical School was performed. Only those patients taking MMF for greater than or equal to six consecutive months were included. Main outcome measures were rate of inflammation control, CS, and MMF discontinuation, as well as visual acuity and side effects. RESULTS: Twenty-two patients (32 eyes) were included in the study. Mean ± SD age was 53.5 ± 13.3 years. Twenty (91%) patients had previously failed some form of immunomodulatory therapy. After 6, 12, 18, and 24 months of consecutive MMF treatment, 91-100% of patients achieved inflammation control. Mean time to resolution of inflammation was 2.8 months, while mean duration of inflammation control was 14.8 months. CS sparing was achieved in 100% of patients at each time point, with mean starting CS dose decreased by 91% at final visit. Vision was stable or improved in 24 (75%) eyes. Fourteen (64%) patients reported side effects including leucopenia (n = 7), gastrointestinal upset (n = 4), abnormal liver function tests (n = 3), and abnormal renal function tests (n = 2). None required hospitalization or medical treatment. Four (18%) patients discontinued MMF due to side effects (n = 3) and treatment ineffectiveness (n = 1). CONCLUSION: MMF is an effective and well-tolerated therapy that can successfully reduce inflammation and decrease CS use in the treatment of chronic non-infectious, non-necrotizing scleritis.