Success With Single-Agent Immunosuppression for Multifocal Choroidopathies

PURPOSE: To evaluate the success of single-agent immunosuppression for patients with the posterior uveitides, birdshot chorioretinitis, multifocal choroiditis with panuveitis, and punctate inner choroiditis. DESIGN: Retrospective case series. METHODS: SETTING: Tertiary care uveitis practices. POPULATION: Patients initiated on immunomodulatory therapy. INTERVENTION: Patients were treated with prednisone 1 mg/kg and mycophenolate 2 g daily. Prednisone was tapered after 1 month. Immunosuppression was escalated to mycophenolate 3 g daily, with addition of a second agent, as needed, to achieve treatment success. OUTCOME MEASURE: Treatment success, defined as no disease activity with prednisone dose <= 10 mg daily, at 6, 12, and 24 months. RESULTS: Twenty-seven patients were followed. Mean presentation and 2-year follow-up acuities were 20/41 and 20/42, respectively. For birdshot chorioretinitis, mean (+/- standard deviation) quantitative Goldmann visual field scores improved from 761 +/- 69 degrees (IV/4 isopter) and 496 +/- 115 degrees (I/4 isopter) at presentation to 784 +/- 57 degrees and 564 +/- 125 degrees, respectively. Prednisone was successfully tapered in 95% of patients; mean prednisone doses at 1 and 2 years were 5.3 +/- 4.1 and 5.7 +/- 4.8 mg/day, respectively. At 2 years, prednisone was discontinued in 11% of patients. Treatment success was achieved in 74% of patients on 1 immunosuppressant, and in an additional 21% of patients on 2 agents, for an overall 95% success rate at 2 years. CONCLUSIONS: Posterior uveitides can be treated with 1 agent in most patients, but the data suggest a need to escalate therapy to higher mycophenolate doses, and in one fifth of cases to add a second agent to maintain disease suppression with acceptably low prednisone doses. (C) 2014 by Elsevier Inc. All rights reserved.