Abstract
Purpose Azathioprine is commonly used as a second-line immunosuppressive agent in the management of patients with retinal vasculitis. The aim of this study was to determine the efficacy of azathioprine by evaluating its effect on relapse rate, clinical outcome and maintenance steroid dose.
Methods A retrospective analysis was performed of 34 patients presenting over 15 years to the Medical Eye Unit at St Thomas' Hospital. Relapse rate, steroid dosage, inflammatory score and visual acuity were assessed before and during treatment with azathioprine.
Results Thirty-four patients (23 male) aged 17-70 years (median 41.4, median 38) were enrolled. Fifteen had idiopathic retinal vasculitis, 12 had Behçet's disease, 2 sarcoidosis, 2 sympathetic ophthalmia, 1 birdshot retinochoriodopathy, 1 Still's disease and 1 Harada's disease. The principal indications for azathioprine treatment were uncontrolled disease despite appropriate steroid therapy in 28 patients (82%) or to permit a decrease in steroid dosage in 6 patients (18%). Frequency of relapse was assessed in 10 patients whose pre-treatment and treatment periods with azathioprine were of 1 year or greater. All were found to have a decreased replapse rate. In 60%, reduction of steroid dosage was achieved. Ocular inflammatory score decreased in 56% of eyes and visual acuity was improved or maintained in 64%. In 8 patients treatment had to be stopped due to side effects.
Conclusion Within the limitations of a retrospective study, we found azathioprine when used in combination with systemic steroids to be most effective at reducing the relapse rate of retinal vasculitis, but only partially effective in allowing a reduction in steroid dosage.
References
Howe LJ, Stanford MR, Edelsten C, Graham EM . The efficacy of systemic corticosteroids in sight-threatening retinal vasculitis. Eye 1994;8:443–7.
Newell FW, Krill AE . Treatment of uveitis with azathioprine (Imuran). Trans Ophthalmol Soc UK 1967;87:499–511.
Lessof MH, Jeffrys DB, Lehner T, Sanders MD . Corticosteroids and azathioprine: their use in Behçet's syndrome. In: Lehner T, Barnes CG, editors. Behçet's syndrome: clinical and immunological features. London: Academic Press, 1979:218–26.
Andrasch RH, Pirofsky B, Burns RP . Immunosuppressive therapy for severe chronic uveitis. Arch Ophthalmol 1978;96:247–51.
Lightman S . Use of steroids and immunosuppressive drugs in the management of posterior uveitis. Eye 1991;5:294–8.
Vitale AT, Rodriguez A, Foster CS . Low dose cyclosporin A therapy in treating chronic, noninfectious uveitis. Ophthalmology 1996;103:365–73; discussion 373-4.
Graham EM, Sanders MD, James DG, Hamblin A, Kasp Grochowska E, Dumonde D . Cyclosporin in the treatment of posterior uveitis. Trans Ophthalmol Soc UK 1985;104:146–51.
Yazici H, Pazarli H, Barnes CG, Tuzun Y, Silman A, Serdaroglu S, et al. A controlled trial of azathioprine in Behçet's syndrome. N Engl J Med 1990;322:281–5.
Hamuryudan V, Ozyazgan Y, Hizli N, Mat C, Yurdakul S, Tuzun Y, et al. Azathioprine in Behçet's syndrome: effects of long-term prognosis. Arthritis Rheum 1997;40:769–74.
Hakin KN, Pearson RV, Lightman SL . Sympathetic ophthalmia: visual results with modern immunosuppressive therapy. Eye 1992;6:453–5.
Kotter I, Durk H, Saal J, Fierlbeck G, Pleyer U, Ziehut M . Therapy of Behçet's disease. Ger J Ophthalmol 1996;5:92–7.
Anstey A, Lennard L, Mayou SC, Kirby JD . Pancytopenia related to azathioprine: an enzyme deficiency caused by a common genetic polymorphism [review]. J R Soc Med 1992;85:752–6.
Weinshilboum RM, Sladek SL . Mercaptopurine pharmacogenetics: monogenic inheritance of erythrocyte thiopurine methyltransferase activity. Am J Hum Genet 1980;32:651–62.
Dumonde DC, Kasp-Grochowska E, Graham E, Sanders MD, Faure JP, de Kozak, van Tuyen V . Anti-retinal autoimmunity and circulating immune complexes in patients with retinal vasculitis. Lancet 1982;2:787–92.
Author information
Authors and Affiliations
Additional information
Supported by the IRIS Fund for the Prevention of Blindness
Rights and permissions
About this article
Cite this article
Greenwood, A., Stanford, M. & Graham, E. The role of azathioprine in the management of retinal vasculitis. Eye 12, 783–788 (1998). https://doi.org/10.1038/eye.1998.203
Issue Date:
DOI: https://doi.org/10.1038/eye.1998.203
Keywords
- Azathioprine
- Immune suppression
- Retinal vasculitis
This article is cited by
-
Leitlinie Nr. 24a Uveitis intermedia
Der Ophthalmologe (2021)
-
Leitlinie Nr. 24b der DOG und BVA
Der Ophthalmologe (2017)
-
Uveitis intermedia
Der Ophthalmologe (2014)
-
Long-term control of cystoid macular oedema in noninfectious uveitis with Mycophenolate Mofetil
International Ophthalmology (2009)