SYSTEMIC DRUG TOXICITY TRENDS IN IMMUNOSUPPRESSIVE THERAPY OF IMMUNE AND INFLAMMATORY OCULAR DISEASE

Purpose: To compare the relative toxicities of six systemic immunosupp ressive drugs and systemic corticosteroids used to treat patients with severe ocular inflammatory disease and to identify factors influencin g their occurrence. Methods: The authors reviewed the clinical records of 602 patients with ocular inflammatory disease treated with immunos uppressive drug therapy and/or systemic corticosteroids for adverse sy stemic effects while undergoing therapy. Proportional hazards regressi on analysis was performed to identify demographic and clinical factors that influence the occurrence of drug toxicity in these patients. Res ults: Immunosuppressive drug treatment was more likely to result in di scontinuation of therapy because of toxic side effects than was cortic osteroid treatment. However, unlike many of the side effects of cortic osteroid treatment, the side effects of immunosuppressive therapy were reversible with reduction in dosage or discontinuation of the drug. G astrointestinal symptoms and hematologic abnormalities accounted for t he majority of reported side effects of the immunosuppressive medicati ons. Neuropsychiatric and endocrine side effects were common in patien ts taking prednisone. In 17 patients treated with prednisone, patholog ic fractures developed, which involved the hips and the spine. Female sex and age older than 60 years also were identified as factors associ ated with intolerance to drug therapy in the authors' study population . Race and type of systemic and ocular disease were not significant fa ctors influencing tolerance to drug therapy. Conclusion: These finding s suggest that when properly administered and monitored for adverse ef fects, most immunosuppressive agents used in the current study have si milar risk profiles with relatively few serious therapeutic mishaps an d largely reversible side effects. In contrast, corticosteroids can re sult in permanent disabilities as a result of long-term treatment.