Corticosteroid-sparing strategies in the treatment of retinal vasculitis in systemic lupus erythematosus.

Abstract

Systemic corticosteroids have been traditionally used in the therapy of retinal vasculitis in patients with systemic lupus erythematosus. The high morbidity associated with long-term corticosteroid therapy has prompted the use of corticosteroid-sparing strategies with cytotoxic agents. This retrospective study summarizes the authors' experience of the last 10 years including 9 systemic lupus erythematosus patients with retinal vasculitis who required treatment for longer than 6 months. Seven of these patients were treated with cytotoxic agents. Average follow-up was 39 months. Inflammation was controlled clinically and angiographically in all patients using the following therapeutic regimens: systemic corticosteroids and hydroxychloroquine (n = 1 patient); systemic corticosteroids and cytotoxic chemotherapy (n = 6); cytotoxic chemotherapy and hydroxychloroquine (n = 1); and hydroxychloroquine alone (n = 1). Visual acuity was preserved (> 20/30) or improved in all patients. All patients retained excellent control of their systemic disease during their follow-up. Side effects of cytotoxic drugs requiring discontinuation of all chemotherapy were not encountered in this group; Imuran therapy did result in substantial adverse effects necessitating its replacement with other drugs. These results suggest a valuable role for corticosteroid-sparing drugs in the therapy of retinal vasculitis associated with systemic lupus erythematosus.