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Ten-year experience of pulsed intravenous cyclophosphamide and methylprednisolone protocol (PICM protocol) in severe ocular inflammatory disease
  1. Imran J Khan1,
  2. Robert J Barry1,2,
  3. Kwesi N Amissah-Arthur1,
  4. David Carruthers3,
  5. Srinivasa Rao Elamanchi3,
  6. Deva Situnayake3,
  7. Philip I Murray1,2,
  8. Alastair K Denniston1,2,
  9. Saaeha Rauz1,2
  1. 1Academic Unit of Ophthalmology, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham and Midland Eye Centre, Birmingham, UK
  2. 2Centre for Translational Inflammation Research, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Birmingham, UK
  3. 3Department of Rheumatology, Sandwell and West Birmingham NHS Trust, City Hospital, Birmingham, UK
  1. Correspondence to Saaeha Rauz, Academic Unit of Ophthalmology, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham and Midland Eye Centre, Dudley Road, Birmingham B18 7QU, UK; s.rauz{at}bham.ac.uk

Abstract

Aims Severe ocular inflammation is a blinding ophthalmological emergency. This study evaluates the efficacy and patient tolerance of a validated regime of pulsed intravenous cyclophosphamide and methylprednisolone (‘PICM protocol’) for these patients.

Methods 26 patients with severe inflammatory eye disease (43 eyes: 22 uveitis, 21 scleritis/sclerokeratitis; median age 52 years (IQR 40.25–62.25)) presenting to a regional tertiary referral centre were recruited over a 10-year period (January 2002–December 2011) into the PICM protocol, comprising intravenous cyclophosphamide 15 mg/kg, intravenous methylprednisolone 10 mg/kg, maximum nine pulses over 20 weeks supplemented with low-dose continuous oral prednisolone. Data were captured pretreatment and at 6 and 12 months follow-up. Primary outcome measures were control of inflammation according to standard criteria and reduction in systemic glucocorticoid to ≤10 mg prednisolone/day.

Results A median of six pulses (IQR 5–6) were administered over a median of 3 months (IQR 2.25–4). In the scleritis/sclerokeratitis group, 15/21(71%) achieved success or partial success at 6 and 12 months versus 9/22 (41%) for the same time points in the uveitis group (χ2=4.058, p=0.044). Two patients had adverse events requiring treatment withdrawal.

Conclusions This PICM protocol is a well-tolerated regimen for managing severe ocular inflammation and appears particularly useful in patients with scleritis/sclerokeratitis.

  • Inflammation
  • Treatment Medical
  • Sclera and Episclera
  • Retina
  • Cornea

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