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Br J Ophthalmol 88:673-680 doi:10.1136/bjo.2003.028472
  • Clinical science
    • Extended reports

Use of corticosteroid sparing systemic immunosuppression for treatment of corticosteroid dependent optic neuritis not associated with demyelinating disease

Table 2

Published cases of optic neuritis treated with corticosteroid sparing therapy6,9–17

First author Year Age/sex Diagnosis Eye* Time and dose of corticosteroid or other therapy Indication for corticosteroid sparing agent Drug, dose, and duration (if reported) Adverse effects Corticosteroid dose (final) Initial visual acuity Final visual acuity Comment
F, female; M, male; OD, right eye; OS, left eye; OU, both eyes; IV, intravenous; NLP, no light perception; HM, hand motion; CF, count fingers; LP, light perception.
*Uninvolved eyes are not detailed in this table.
Siatkowski RM 2001 32 F Systemic lupus erythematosus OU 6 months of corticosteroid 3 relapses on corticosteroid Monthly IV cyclophosphamide for 7 months, no relapses while on therapy Unknown Unknown OD:LP OS:20/15 OD:5/200 OS:20/200 Patient discontinued cyclophosphamide because she desired to become pregnant.
42 F OD Unknown Unknown Azathioprine for 16 months, then monthly IV cyclophosphamide Unknown 20 mg OD:20/200 OD:20/40
Frohman LP 2001 51 F Systemic lupus erythematosus OU 5mg/2.5 mg and hydroxychloroquine 400 mg daily Unknown Methotrexate 15 mg weekly Unknown 0 mg OD:LP OS:20/70 OD:20/20 OS:20/20
Galindo-Rodriguez G 1999 41 F Systemic lupus erythematosus OU 100 mg for 2 months Disease refractory to corticosteroid and/or oral immunosuppression Cyclophosphamide 0.5–1.0 gm/m2 IV on 2 consecutive days monthly. Mean duration 5 months All patients had side effects: 7 patients with urinary tract infections, 3 patients with upper respiratory infections, 2 patients with herpes zoster infections, 1 patient with pneumonia, 4 patients with oral candidaisis, 5 patients with hair loss, 1 patient with cutaneous abcess. Unknown OD:20/40 OS:HM OD:20/30 OS:20/30 Only 3 patients discontinued treatment and this was secondary to nausea and vomiting.
35 F OU 100 mg for 4 months OD:CF OS:CF OD:20/50 OS:20/100
36 F OU 60 mg for 8 months and azathioprine 150 mg for 9 months and cyclophosphamide by mouth for 12 months OD:CF OS:CF OD:20/50 OS:20/20
18 F OU 60 mg for 24 months and azathioprine 100 mg for 24 months and cyclophosphamide by mouth for 6 months OD:NLP OS:CF OD:CF OS:20/200
44 F OU 100 mg for 4 months and azathioprine 150 mg for 20 months and cyclophosphamide by mouth for 4 months OD:CF OS:CF OD:20/25 OS:20/30
55 F OU 100 mg for 2 months OD:20/70 OS:20/70 OD:20/20 OS:20/20
43 F OU 100 mg for 2 months OD:CF OS:CF OD:20/60 OS:20/80
17 F OU 100 mg for 3 months and azathioprine 100 mg for 2 months OD:CF OS:CF OD:20/20 OS:20/25
32 F OU 150 mg for 4 months OD:HM OS:20/40 OD:HM OS:20/60
30 F OU 60 mg for 1 month OD:20/20 OS:20/25 OD:20/30 OS:20/40
Rosenbaum JT 1997 32 F Systemic lupus erythematosus OS Unknown doses of corticosteroid and azathioprine Unknown IV cyclophosphamide for 28 months Unknown Unknown OD: HM OD: 20/20
56 F OD Unknown dose IV cyclophosphamide for 2 months OD: LP OD: 20/30
Maust HA 2003 35F Sarcoidosis OU 20–40 mg daily for 5 months Insomnia, anxiety Methotrexate 2.5–10 mg weekly for 30 months Leukopenia in one patient 0 mg OD:CF OS: 20/400 OD:20/50 OS: 20/20
41F OD 10–40 mg daily for 2 months Hyperglycaemia Methotrexate 2.5–10 mg weekly for 36 months 18 mg OD: CF OD: 20/30
47F OU 10–80 mg daily for 8 months Mood swings, insomnia, weight gain, depression, alopecia Methotrexate 7.5–15 mg weekly for 23 months 0 mg OD: HM OS: 20/20 OD: NLP OS: 20/25
Bielory L 1991 48 F Orbital pseudotumor OS Unknown dose 4 patients with weight gain, 2 patients with uncontrolled hyperglycaemia, 2 patients with hypertension Cyclosporine A 2 mg/kg/day for an average of 16.5 months Hypercholesterolaemia and hirsutism in unknown number of patients Unclear OS: 20/400 OS: 20/20 Weight gain, diabetes and hypertension resolved in all patients after corticosteroid dose was tapered.
38 M Sarcoidosis OU OD:20/20 OS: 20/25 “Normal acuity”
56 F OU OD:20/200 OS:20/200 OD:CF OS:20/400
25 M OU OD:20/40 OS:20/200 OD:20/30 OS:20/200
Gelwan MJ 1988 45 F Sarcoidosis OU Unknown dose Hypertension and diabetes 4500 cGy of radiation then azathioprine 800 mg daily for 8 months Unknown 10 mg OD:20/40 OS:20/100 OD:20/25 OS:20/20
32 M OU Diabetes, cushingoid, glaucoma 4500 cGy of radiation then azathioprine 200 mg daily for 5 months None 10 mg every other day OD:20/40 OS:NLP OD:20/60 OS:NLP Diabetes and cushingoid features resolved
20 M OU Cushingoid 4880 cGy of radiation then chlorambucil 6 mg daily for 6 months Unknown 7.5 mg OD:20/20 OS:20/200 OD:20/20 OS:CF Poor compliance
Gressel MG 1983 21 F Mixed connective tissue disease OU 40 mg daily Cushingoid Azathioprine for 7 months, then oral cyclophosphamide 100 mg daily for 5 months then chlorambucil 4 mg daily Hemorrhagic cystitis and leukopenia on cyclophos-phamide Unknown OD:20/40 OS:20/25 Unknown Rapid progression despite treatment
Purvin A 1994 32 F Neuroretinitis OU Unknown dose Inefficacy Azathioprine for 3 years Unknown Unknown Unknown OD:20/20 OS:20/80 Recurrent attacks suppressed with azathioprine
Kupersmith MJ 1988 44 F Autoimmune optic neuropathy OD 100 mg daily for 12 months Corticosteroid intolerance or inefficacy Chlorambucil 6 mg daily for 6.5 years None “lower” OD: LP OS: 20/20 OD: 20/25 OS: 20/20
42 F OU 100 mg daily for 4 months Chlorambucil 6 mg daily for 6.5 years None “lower” OD: NLP OS: LP OD: NLP OS: 20/20
26 F OU 100 mg daily for 3 months Cyclophosphamide 150 mg and Azathioprine 100 mg daily for 5.5 years Pneumocystis pneumonia “reduced” ODHM OS: HM OD: 20/25 OS: 20/25
26 F OU 100 mg daily for 1.5 months Chlorambucil 6 mg and Azathioprine 75 mg daily for 6.5 years Herpetic keratitis “lower” OD: CF OS: 20/300 OD: 20/25 OS: 20/300
56 F OD Unknown dose Azathioprine 125 mg daily for 6 months None 30 mg OD: 20/400 OS: 20/20 OD: 20/30 OS: 20/20
47 F OS 20 mg daily for 1 months Azathioprine 50 mg daily for 1 week None 60 mg OD: 20/20 OS: 20/400 OD: 20/20 OS: 20/40 Patient refused treatment after one week.
45 M OU 60 mg daily for 1 months Chlorambucil 8 mg daily for 18 months None 5 mg OD: LP OS: NLP OD: 20/50 OS: LP
Azathioprine 200 mg daily
Chlorambucil 6 mg daily for over three years
27 F OU 80 mg daily for 1 months Chlorambucil 6 mg daily for 18 months Agranulocytosis and sepsis 10 mg OD: 20/60 OS: NLP OD: 20/20 OS: CF Chlorambucil disontinued because of episode of sepsis.
Azathioprine 200 mg daily for 4 years None
Dutton JJ 1982 44 F Autoimmune retrobulbar optic neuritis OU Unknown dose Unknown Chlorambucil 6 mg daily for 2 years Unknown 0 mg OD:20/80 OS:20/25 OD:20/20 OS:20/20
26 F OU Cushingoid, depression Chlorambucil 6 mg daily and azathioprine 75 mg daily for 1 year OD:CF OS:CF OD:20/30 OS:20/300
42 F OD Unknown Chlorambucil 6 mg daily for 6 months LP 20/20

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