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Safety profile and efficacy of tacrolimus in the treatment of birdshot retinochoroiditis: a retrospective case series review
  1. Farrah Islam1,2,
  2. Mark Westcott1,3,
  3. Angela Rees1,
  4. Anthony George Robson1,3,
  5. Bharat Kapoor1,
  6. Graham Holder1,3,
  7. Carlos Pavesio1,3
  1. 1Department of Medical Retina, Moorfields Eye Hospital, London, UK
  2. 2Vitreoretinal department, Al-ShifaTrust Eye Hospital, Rawalpindi, Pakistan
  3. 3Medical retina, Institute of Ophthalmology, University College London, London, UK
  1. Correspondence to Dr Farrah Islam, Department of Vitreo retina, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan; farrahislam{at}gmail.com

Abstract

Aim Evaluation of the use of tacrolimus in the treatment of birdshot retinochoroiditis (BRC) at a tertiary referral centre with the aim to describe its safety and efficacy.

Methods The medical records of 25 patients diagnosed with BRC at uveitis service, Moorfields Eye Hospital, and who had received tacrolimus treatment were retrospectively reviewed. The main outcome measures of the study were (1) safety of tacrolimus in terms of side effects and (2) efficacy, as measured both by control of inflammation and visual function assessed by Humphrey visual fields and electrophysiological testing over at least 6 months and then 1 year.

Results Tacrolimus was commenced in 25 patients (mean age 50.4±10.8 years) and was well tolerated in 21 patients (84%). It was necessary to stop the tacrolimus in four patients. No patient showed major changes in renal function: 3/21 patients (14.28%) showed slightly abnormal (less than 30%) function at the end of the first month of treatment; 1/21 (4.76%) patients at 3 months, but at the end of a 6-month treatment period only 1/21 patients (4.76%) showed minor abnormality in renal function. The mean daily prednisolone dose was 19.7 mg at the beginning of the study, which had fallen to 6.9 mg at the end (t=5.071, p=0.001). Visual acuity mostly remained stable. Visual fields improved over time (mean improvement in Humphrey mean deviation, right eye=1.8±2.4 dB, t=3.821, p=0.004; left eye=1.9±2.7, dB, t=3.06, p=0.007). Electrophysiological function showed improvement in 10 patients, and in four patients an initial deterioration in function improved following tacrolimus dose adjustment.

Conclusion Tacrolimus has a good safety profile for long-term use in patients with BRC as a second-line agent enabling steroid sparing and visual function stabilisation or improvement.

  • drugs
  • immunology
  • retina
  • inflammation

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Footnotes

  • Contributors FI, MW substantially contributed to the conception and design of the work, the acquisition, analysis and interpretation of data for the work and drafting the work or revising it critically for important intellectual content. AR, AGR, BK contributed to acquisition, analysis and interpretation of data for the work and drafting the work or revising it critically for important intellectual content. GH and CP contributed to interpretation of data for the work and drafting the work or revising it critically for important intellectual content.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Ethical Review Board, Moorfields Eye Hospital, London.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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