Ten-year experience of pulsed intravenous cyclophosphamide and methylprednisolone protocol (PICM protocol) in severe ocular inflammatory disease. Issue 9 (30th November 2012)

• Record Type: Journal Article
• Authors: Khan, Imran J; Barry, Robert J; Amissah-Arthur, Kwesi N; Carruthers, David; Elamanchi, Srinivasa Rao; Situnayake, Deva; Murray, Philip I; Denniston, Alastair K; Rauz, Saaeha
• Is Part Of: British journal of ophthalmology. Volume 97:Issue 9(2013)
• Page Start: 1118
• Page End: 1122
• Publication Date: 2012-11-30
• Subjects: Inflammation -- Treatment Medical -- Sclera and Episclera -- Retina -- Cornea; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2012-302130
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Aims: Severe ocular inflammation is a blinding ophthalmological emergency. This study evaluates the efficacy and patient tolerance of a validated regime of pulsed intravenous cyclophosphamide and methylprednisolone ('PICM protocol') for these patients. Methods: 26 patients with severe inflammatory eye disease (43 eyes: 22 uveitis, 21 scleritis/sclerokeratitis; median age 52 years (IQR 40.25–62.25)) presenting to a regional tertiary referral centre were recruited over a 10-year period (January 2002–December 2011) into the PICM protocol, comprising intravenous cyclophosphamide 15 mg/kg, intravenous methylprednisolone 10 mg/kg, maximum nine pulses over 20 weeks supplemented with low-dose continuous oral prednisolone. Data were captured pretreatment and at 6 and 12 months follow-up. Primary outcome measures were control of inflammation according to standard criteria and reduction in systemic glucocorticoid to ≤10 mg prednisolone/day. Results: A median of six pulses (IQR 5–6) were administered over a median of 3 months (IQR 2.25–4). In the scleritis/sclerokeratitis group, 15/21(71%) achieved success or partial success at 6 and 12 months versus 9/22 (41%) for the same time points in the uveitis group (χ 2 =4.058, p=0.044). Two patients had adverse events requiring treatment withdrawal. Conclusions: This PICM protocol is a well-tolerated regimen for managing severe ocular inflammation and appears particularly useful in patients with scleritis/sclerokeratitis.