Tacrolimus for immunosuppression in patients with non-infectious intermediate, posterior, or panuveitides.

Abstract

To evaluate the effectiveness of tacrolimus in patients with non-infectious intermediate, posterior, or panuveitis needing a two-immunosuppressive-agent regimen. Design: Retrospective cohort study. Setting: Two tertiary-care uveitis practices at academic medical centers. Patient population: 32 patients with non-infectious intermediate, posterior, or pan-uveitides in whom single agent immunosuppression was inadequate to effect successful corticosteroid sparing. Intervention: tacrolimus, added as the second immunosuppressive agent. Main outcome measure: successful corticosteroid sparing, defined as inactive uveitis at a dose of prednisone <7.5 mg/day. Active uveitis was present in 65.6% of patients at initiation of tacrolimus, and the median time to inactive uveitis was 1.5 months (95% confidence interval [CI] 1.2, 4.08). The median time to successful corticosteroid sparing was 3.9 months (95% CI 1.41, 6.67), and by 6 months of follow-up successful corticosteroid sparing was achieved in 75% of patients. Tacrolimus was discontinued for side effects in 5 patients, 3 for tremor and 2 for hyperglycemia. All side effects were reversible with tacrolimus discontinuation. Tacrolimus appears to have efficacy as a second immunosuppressive agent in two-immunosuppressive drug regimens, when a single agent does not permit successful corticosteroid sparing. Side effects were reversible with tacrolimus discontinuation.