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SAT0595 Analysis of recurrences after suspension of immunosuppressive treatment in non-infectious uveitis
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  1. M. Uriarte1,
  2. C. Martín2,
  3. J. Gonzalez2,
  4. R. García de Vicuña1,
  5. E. Pato3,
  6. M. Gorroño4,
  7. Á. M. Aparicio5,
  8. M. Cordero6
  1. 1Rheumatology
  2. 2Opthalmology, Hospital Universitario La Princesa
  3. 3Rheumatology, Hospital Clínico San Carlos
  4. 4Opthalmology, Hospital Príncipe de Asturias, Madrid
  5. 5Rheumatology, Hospital Virgen de la Salud, Toledo
  6. 6Opthalmology, Hospital Universitario de León, León, Spain

Abstract

Background Uveitis is the most common ocular inflammatory disease. According to the classification, non-infectious uveitis 70% of the total, presenting a chronic course and with it, an increased risk of complications. The phased therapeutic approach in ophthalmology is well established and is based on the efficacy of synthetic and biological immunosuppressive therapy.1 However, we do not have evidence-based protocols that allow us to know how long to maintain them, or when to interrupt them.

Objectives The main objective is to evaluate the free time without ocular inflammatory activity after the withdrawal of the synthetic and/or biological immunosuppressive treatment in patients with non-infectious uveitis.

As secondary objectives are collected the epidemiological and clinical characteristics, the distribution of the different immunosuppressive drugs employed and analysed the cases of recurrence after the interruption of treatment, and the need of reintroduction.

Methods A retrospective cohort multicenter study was conducted in patients with a diagnosis of non-infectious uveitis followed in a multidisciplinary unit, that after two or more years of ocular and extraocular inactivity, the inmunossuppresive treatment was suspended. It was defined inactive uveitis as cell Tyndall 0 in anterior and vitreous chamber, as well as the absence of other signs of active inflammation (retinal infiltrates, choroid and vasculitis and/or papillitis with angiographic leakage).

Demographic characteristics, anatomical location and laterality of the uveitis, visual acuity at the beginning and end of the study and the drugs used were recorded.

Results We analysed 48 patients with an average age at the onset of immunosuppressive treatment of 39.3 years (±16 years). 85.4% of the uveitis were bilateral. The main diagnoses are described in table 1. In 56.3% of cases a single immunosuppressant was used. Cyclosporine was the most employed (72.9%) and methotrexate was the most used in monotherapy (83.3%). 83% of patients received corticosteroids and 12% treatment with Infliximab. The mean duration of immunosuppressive treatment was 6.9 years (±5, 7años). The percentage of total and ocular recurrence was 37.5% and 31.25% respectively. The mean duration of follow-up after treatment suspension was 4.3 years (±4.5 years), being more than 1 year in 77.1% of patients. We found that 75% of patients remained free of recurrence at least 27 months. The administration of two or more immunosuppresive drugs proved to be a risk factor for recurrence (p=0,048) and reintroduction of treatment after it (p=0,008), which was performed in 39% of the ocular recurrences. Visual acuity did not suffer variation in 78.6% of recurrences and 80.3% of those that did not recur.

Abstract SAT0595 – Table 1

- Main diagnoses

Conclusions In our cohort, patients with no ocular inflammatory activity for at least two years could benefit from the suspension of immunosuppressive treatment without a visual risk. The use of one or more immunosuppressive drugs has been identified as a risk factor for recurrence.

Reference [1] Update on the principles and novel local and systemic therapies for the treatment of non-infectious uveitis. Inflamm Allergy Drug Targets2013;12(1):38–45.

Disclosure of Interest None declared

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