AN ANALYSIS OF THERAPEUTIC DECISION FOR SCLERITIS

Purpose: To compare the long-term efficacy of different systemic thera peutic regimens for patients with noninfectious anterior scleritis to establish guidelines for institution of therapy. Methods: Therapeutic failure of systemic nonsteroidal anti-inflammatory drugs (NSAIDs), sys temic steroidal anti-inflammatory drugs, and systemic nonsteroidal imm unosuppressive drugs was evaluated in 132 patients with noninfectious anterior scleritis (diffuse, nodular, or necrotizing types). Results: In patients with diffuse scleritis, therapeutic failure for initial re gimens occurred in 7% of patients treated with NSAIDs, in 16% of patie nts treated with steroids, and in 27% of patients treated with immunos uppressive drugs. In patients with nodular scleritis, therapeutic fail ure for initial regimens occurred in 9% of patients treated with NSAID s, in 28% of patients treated with steroids, and in 25% of patients tr eated with immunosuppressive drugs. Addition or substitution of steroi ds or immunosuppressive drugs as second- or third-line therapies helpe d control the scleritis. In patients with necrotizing scleritis, thera peutic failure for initial regimens occurred in 1 00% of patients trea ted with NSAIDs, in 91% of patients treated with steroids, and in 26% of patients treated with immunosuppressive drugs. Conclusions: In pati ents with diffuse and nodular scleritis, NSAIDs should be the initial choice; in case of therapeutic failure, steroids should be added or su bstituted as second-line therapy, tapering and discontinuing them as s oon as possible while maintaining remission with continued NSAIDs; in case of therapeutic failure, immunosuppressive drugs should be added o r substituted as third-line therapy. In patients with necrotizing scle ritis, immunosuppressive drugs should be the initial choice.