Inflammatory Relapses after Immunosuppressive Drug Discontinuation in Uveitis Patients: A Survival Analysis

ABSTRACT

Purpose: To estimate the incidence rate (IR) and identify risk factors associated to inflammatory relapse after immunosuppressive drug (ISD) discontinuation in noninfectious uveitis patients.

Methods: Multicenter longitudinal retrospective study, including patients from four uveitis clinics followed-up until December 2018. Hazard ratios for different variables were estimated using multivariable Cox models.

Results: 32 patients (34 episodes of ISD discontinuation) were analyzed (median and maximum follow-up time: 2.4 and 19.2 years, respectively). Fourteen patients presented at least one relapse: anterior (8 patients), intermediate (5) and posterior (8). IR (95% confidence interval) of the first relapse was 14.3 (8.6–23.8) episodes per 100 patient-years (median survival time: 4.8 years). Early use of ISDs, panuveitis, and higher oral corticosteroid dosage at discontinuation were associated with higher hazards of relapse in multivariable analysis.

Conclusions: Relapse is a frequent and early event after ISD discontinuation. Identifying relapse risk factors could support the physician’s decision regarding ISD discontinuation.

Keywords:

• immunosuppressive drug
• inflammatory relapse
• oral corticosteroids
• uveitis

Acknowledgments

We would like to thank Pedro López-Romero (Senior Research Scientist/Senior Statistician at Eli Lilly and Company) for reviewing the statistical methods used in this work; and the Members of the Madrid Uveitis Study Group (see Supplementary MUSG list).

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Supplementary Material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

This work was supported by the Instituto de Salud Carlos III (ISCIII), Ministry of Health, Spain [Miguel Servet research type 2 contract: CPII17/00014 to LRR]. Funders had no role in the design, collection, management, analysis, interpretation of the data, preparation, review, approval or decision to submit the manuscript for publication.