CORTICOSTEROID-SPARING STRATEGIES IN THE TREATMENT OF RETINAL VASCULITIS IN SYSTEMIC LUPUS ERYTHEMATOSUS

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Abstract

Background:

Systemic corticosteroids have been traditionally used in the therapy of retinal vasculitis in patients with systemic lupus erythematosus. The high morbidity associated with long-term corticosteroid therapy has prompted the use of corticosteroid-sparing strategies with cytotoxic agents.

Methods:

This retrospective study summarizes the authors' experience of the last 10 years including 9 systemic lupus erythematosus patients with retinal vasculitis who required treatment for longer than 6 months.

Results:

Seven of these patients were treated with cytotoxic agents. Average follow-up was 39 months. Inflammation was controlled clinically and angiographically in all patients using the following therapeutic regimens: systemic corticosteroids and hydroxychloroquine (n=1 patient); systemic corticosteroids and cytotoxic chemotherapy (n=6); cytotoxic chemotherapy and hydroxychloroquine (n=1); and hydroxychloroquine alone (n=1). Visual acuity was preserved (>20/30) or improved in all patients. All patients retained excellent control of their systemic disease during their follow-up. Side effects of cytotoxic drugs requiring discontinuation of all chemotherapy were not encountered in this group; Imuran therapy did result in substantial adverse effects necessitating its replacement with other drugs.

Conclusion:

These results suggest a valuable role for corticosteroid-sparing drugs in the therapy of retinal vasculitis associated with systemic lupus erythematosus.

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