Immunomodulatory Therapy Discontinuation for Reasons Other Than Efficacy in the Treatment of Ocular Inflammation.

Abstract

Purpose: Immunomodulatory therapy (IMT) is commonly used in the treatment of chronic ocular inflammation. While there is substantial data on their efficacy, comparatively little data is available on their relative tolerability and safety. Here, we compare the discontinuation rates for reasons other than efficacy for both conventional IMT (cIMT) - methotrexate, mycophenolate, and azathioprine - and biologic IMT (bIMT) - adalimumab and infliximab - in the treatment of ocular inflammation.

Methods: A retrospective cohort study was performed for patients treated with IMT for ocular inflammation between 2013 and 2024 at the University of Colorado Hospital. Data collected for each patient use of a relevant IMT agent included patient sex, race/ethnicity, age, ocular and systemic inflammation diagnosis, duration of therapy, and reason for IMT discontinuation. The primary outcomes were discontinuation rates and time to discontinuation of IMT by reason, which was separated into tolerability; safety; insurance changes, excessive cost, or patient preference; lack of efficacy for ocular inflammation; lack of efficacy for systemic inflammation; or to evaluate for drug-free remission.

Results: 455 patients with 760 unique patient-drug records were included. Discontinuation rates for any reason differed between the five drugs (p = 0.005), and specifically differed for reason of tolerability (p < 0.0001). The time to discontinuation for reasons other than efficacy was significantly shorter for cIMT as compared to bIMT (p < 0.0001).

Conclusions: Similar to findings in other inflammatory diseases, bIMT was better tolerated than cIMT in the treatment of ocular inflammation.