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The effect of methotrexate and sulfasalazine on the course of HLA-B27-positive anterior uveitis: results from a retrospective cohort study

  • Inflammatory Disorders
  • Published:
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Abstract

Purpose

To investigate the effect of methotrexate (MTX) or sulfasalazine (SSZ) on the course of HLA-B27-positive, remitting acute anterior uveitis (AAU).

Methods

Forty-six patients with HLA-B27-positive AAU with or without associated systemic rheumatic disease either receiving MTX (n = 20), SSZ (n = 13), or no systemic immunomodulating treatment (Ctrl; n = 13) were studied retrospectively. Best-corrected visual acuity (BCVA), AAU relapse rate, and occurrence of uveitis-related ocular complications were analyzed at baseline (BL) and at 12-month follow-up (FU).

Results

Groups did not differ regarding age, gender, and presence of associated systemic diseases. BCVA at baseline was significantly worse in patients receiving MTX (logMAR 0.39 ± 0.4) than in those treated with SSZ (0.17 ± 0.2; P = 0.05) or in controls (Ctrl; 0.14 ± 0.2; P = 0.009). At the 12-month endpoint, MTX treatment was associated with significantly improved BCVA (0.18 ± 0.4 logMAR; P = 0.004). In contrast, BCVA did not significantly change in patients treated with SSZ (0.17 ± 0.3 logMAR) or in the controls (0.11 ± 0.2 logMAR). The annual uveitis relapse rate significantly decreased with MTX (BL 3.6 ± 2.4 relapses to FU 0.7 ± 0.8; P = 0.0001) and SSZ (BL 3.6 ± 1.9 to FU 1.8 ± 2.4, P < 0.01), but not in the controls (BL 1.9 ± 1.4 vs 1.9 ± 1.7 FU). The complication rate was slightly reduced with MTX (BL 1.75 ± 1.2 complications present versus FU 1.3 ± 1.2, P = 0.09) but not with SSZ (BL 0.9 ± 0.8 to FU 1.3 ± 1.4; P = 0.4) or in the controls (BL and FU 1.0 ± 0.95; P = 0.7).

Conclusions

MTX and SSZ reduced the uveitis relapse rate in HLA-B27-positive AAU patients, with MTX showing a beneficial effect on AAU-related macular edema.

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Authors and Affiliations

  1. Department of Ophthalmology and Ophtha-Lab at St. Franziskus Hospital, Hohenzollernring 74, 48145, Muenster, Germany

    Melissa Meyer zu Hoerste, Karoline Walscheid, Beatrix Zurek-Imhoff, Carsten Heinz & Arnd Heiligenhaus

  2. Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

    Christoph Tappeiner

  3. University of Duisburg-Essen, Duisburg, Germany

    Carsten Heinz & Arnd Heiligenhaus

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  1. Melissa Meyer zu Hoerste
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Correspondence to Karoline Walscheid.

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The study design conforms to the standards currently applied in Germany. No institutional review board approval or informed consent is required for chart review studies based on fully anonymized data as provided to the study directly by the treating physician.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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zu Hoerste, M.M., Walscheid, K., Tappeiner, C. et al. The effect of methotrexate and sulfasalazine on the course of HLA-B27-positive anterior uveitis: results from a retrospective cohort study. Graefes Arch Clin Exp Ophthalmol 256, 1985–1992 (2018). https://doi.org/10.1007/s00417-018-4082-x

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  • DOI: https://doi.org/10.1007/s00417-018-4082-x

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