Eye involvement is identified in more than 30% of sarcoidosis patients. Uveitis, retinitis, and optic neuritis are often associated with chronic sarcoidosis. Although corticosteroids can be effective therapy, long term usage can create several toxicities, including glaucoma and cataracts. To evaluate methotrexate as a corticosteroid-sparing agent for ocular sarcoidosis, we report our current experience with methotrexate in patients with ocular sarcoidosis.
A retrospective review was performed of sarcoidosis patients treated at one institution from 2002–2009. Data was collected and analyzed from all ocular sarcoidosis patients who had received methotrexate at any time during their disease course.
We identified a total of 335 sarcoidosis patients with ocular disease who had received methotrexate. Of these, 48 (14%) patients were successfully treated with methotrexate, and they remained in remission off therapy during the six years of study follow-up. Of the remaining patients, 109 (32%) received single agent methotrexate, and 39 (11%) patients received methotrexate plus 10 mg or less of daily prednisone. Forty (12%) patients discontinued methotrexate either because of lack of response (26 patients) or toxicity (14 patients). In 41 (12%) of the remaining patients, methotrexate was used in combination with other immunosuppressive agents or tumor necrosis factor (TNF) alpha inhibitors. Methotrexate was administered with leflunomide in 14 (4%) patients or azathioprine in 18 (5%) patients. The remaining patients received methotrexate with TNF inhibitors, including nine (3%) patients on infliximab (7 patients) or adalimumab (2 patients). At the last patient visit, 58 patients (20%) still required more than 10 mg prednisone daily.
Methotrexate was an effective corticosteroid lowering agent in over half of patients with ocular sarcoidosis. In 80% of cases, usage of methotrexate as a single agent or in combination with other immunosuppressive drugs reduced the daily dosage of prednisone to 10 mg or less. This agent was well tolerated with less than 5% of sarcoidosis patients discontinuing drug due to toxicity.
Methotrexate is an effective corticosteroid sparing agent for ocular sarcoidosis.
Robert Baughman, Grant monies (from sources other than industry) Appleby Research; Product/procedure/technique that is considered research and is NOT yet approved for any purpose. Methotrexate, prednisone, azathioprine, leflunomide, infliximab, adalimumab are not FDA approved for treatment of sarcoidosis