Purpose
To assess the efficacy of immunomodulatory therapy in achieving remission and long-term control of inflammation in patients with multiple sclerosis-associated uveitis.
Methods
We did a retrospective case series study on the clinical records of 10 patients with uveitis and multiple sclerosis, treated at the Massachusetts Eye Research and Surgery Institution. The period of study was from July 2005 until November 2012. The evaluation of effectiveness was based on the control of intraocular inflammation.
Results
All patients were female, white, with mean age 49.3 years. Intermediate uveitis was diagnosed in 6 cases (60%), panuveitis - in 3 (30%), posterior - in 1 (10%). Bilateral involvement was present in all (100%) patients.
Immunomodulatory medications as monotherapy included methotrexate - in 5 (50%), mycophenolate mofetil - in 4 (40%), daclizumab - in 2 (20%), cyclophosphamide - in 2 (20%), methotrexate - in 1 (10%), and cyclosporin - in 1 (10%) patient. Combined therapy was used with mycophenolate mofetil and cyclosporine in 4 cases (40%), cyclosporin and azathioprine - in 2 (20%), and methotrexate and cyclosporin - in 1 (10%).
Corticosteroids were used by all patients. Seven patients (70%) had systemic therapy for multiple sclerosis with Glatiramer acetate in 3 (30%) of them, interferon beta-1a - in 3 (30%), and interferon beta-1b - in 1 (10%). At the end of follow-up, 1 patient (10%) was in remission for 19 months following azathioprine therapy, 2 (20%) - quiescent with no immunomodulatory therapy or corticosteroids for 6 and 12 months, with no previous stable remission, 1 (10%) - stable on mycophenolate mofetil and cyclosporin for 21 months, 2 (20%) - maintained on immunomodulatory therapy and corticosteroids for 8 and 37 months, 5 eyes of 3 patients - quiescent after fluocinolone acetonide intravitreal implant for as long as 60 months, 3 eyes of 2 patients had signs of active disease.
Conclusions
Non-corticosteroid conventional systemic immunomodulatory medications can maintain long-term control of intraocular inflammation in multiple sclerosis - associated uveitis. The specific multiple sclerosis disease modifying drugs in our study, which were IFN beta-1b, IFN beta-1a, and glatiramer acetate, were efficacious for the management of the non-ocular manifestations of MS but we could not demonstrate a definitive benefit in the control of ocular inflammation, prevention of complications, and steroid-sparing.
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