Azathioprine for Ocular Inflammatory Diseases

Sirichai Pasadhika, John H. Kempen, Craig W. Newcomb, Teresa L. Liesegang, Siddharth S. Pujari, James T. Rosenbaum, Jennifer E. Thorne, C. Stephen Foster, Douglas A. Jabs, Grace A. Levy-Clarke, Robert B. Nussenblatt, Eric B. Suhler

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174 Scopus citations


Purpose: To evaluate treatment outcomes of azathioprine for noninfectious ocular inflammatory diseases. Design: Retrospective cohort study. Methods: Medical records of 145 patients starting azathioprine as a sole noncorticosteroid immunosuppressant at 4 tertiary uveitis services were reviewed. Main outcome measures included control of ocular inflammation, sustained control after tapering prednisone to ≤ 10 mg/day, and discontinuation of treatment because of side effects. Results: Among 145 patients (255 eyes) treated with azathioprine, 63% had uveitis, 23% had mucous membrane pemphigoid, 11% had scleritis, and 3% had other inflammatory diseases. By Kaplan-Meier analysis, 62% (95% confidence interval [CI], 50% to 74%) of patients with active disease initially gained complete inactivity of inflammation sustained over at least 28 days within 1 year of therapy, and 47% (95% CI, 37% to 58%) tapered systemic corticosteroids to ≤ 10 mg daily while maintaining control of inflammation within 1 year of therapy. Treatment success was most common for intermediate uveitis (90% with sustained inactivity within 1 year; 95% CI, 64% to 99%). Over the median follow-up of 230 days (interquartile range, 62 to 679 days), azathioprine was discontinued at a rate of 0.45 per person-years (/PY): 0.16/PY because of side effects, 0.10/PY because of ineffectiveness, 0.09/PY because of disease remission, and 0.10/PY because of unspecified causes. Conclusions: Azathioprine was moderately effective as a single corticosteroid-sparing immunosuppressive agent in terms of control of inflammation and corticosteroid-sparing benefits, but required several months to achieve treatment goals; it seems especially useful for patients with intermediate uveitis. Treatment-limiting side effects occurred in approximately one-fourth of patients within 1 year, but typically were reversible.

Original languageEnglish (US)
Pages (from-to)500-509.e2
JournalAmerican journal of ophthalmology
Issue number4
StatePublished - Oct 2009

ASJC Scopus subject areas

  • Ophthalmology


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