Corticosteroids with or without Conventional Disease-Modifying Antirheumatic Drug as First-Line Therapy in Nonanterior Sarcoidosis Uveitis

Abstract

Purpose: Sarcoidosis is one of the leading causes of noninfectious uveitis. Systemic immunosuppressive treatment is required in 45% to 70% of patients for severe intermediate or posterior uveitis, and relapses are frequent (30%-60%) during follow-up. We aimed to compare the efficacy and safety of systemic corticosteroid therapy alone versus corticosteroid plus conventional disease-modifying antirheumatic drugs (C-DMARDs) as first-line therapy in patients with nonanterior sarcoidosis uveitis.

Design: We conducted a multicenter, retrospective study.

Participants: One hundred sixty-three patients with nonanterior sarcoidosis-related uveitis were included.

Methods: We compared first-line therapy with systemic corticosteroids alone (CTC; n = 122) versus corticosteroids plus C-DMARDs (CTC-DMARD; n = 41).

Main outcome measures: The primary outcome was treatment failure-free survival (TFFS) defined by the discontinuation of treatment for inefficiency or the occurrence of relapse.

Results: Treatment failure-free survival at 12 months was 0.83 (95% confidence interval [CI], 0.67-0.91) and 0.65 (95% CI, 0.55-0.72), respectively, in the CTC-DMARD and CTC groups. In multivariable analysis adjusted on multifocal choroiditis and baseline dose of corticosteroids, the TFFS was significantly higher in the CTC-DMARD group compared with the CTC group (hazard ratio, 2.21; 95% CI, 1.18-4.14; P = 0.01). A significant steroid-sparing effect at 3 and 6 months was noted (P < 0.05) in the CTC-DMARD group compared with the CTC group. Fourteen patients (34%) and 50 patients (41%) experienced at least 1 adverse event in the CTC-DMARD and CTC groups, respectively.

Conclusions: In nonanterior sarcoidosis-associated uveitis, the CTC-DMARD seemed to be more efficient than CTC, with an acceptable safety profile.

Financial disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Keywords: Corticosteroids; DMARD; Relapses; Sarcoidosis; Uveitis.