AIM To evaluate the clinical usefulness of methotrexate in patients with non–infectious ocular and orbital inflammatory disease who fail to respond to systemic corticosteroids

METHODS One year prospective study involving patients with non–infectious ocular and orbital inflammatory disease who were treated with methotrexate at a tertiary health care centre from march 2017 to February 2018.. Methotrexate was administered at a median maximum dose of 20 mg per week (range 15–25 mg per week) in conjunction with folate supplementation. Patients were followed with regular ophthalmic examinations, as well as serum liver enzyme levels and blood cell counts. Clinical signs of regression of the ocular and orbital inflammation, visual acuity, dosage and duration of methotrexate therapy, requirement for concurrent corticosteroid administration, and adverse drug reactions were recorded.

RESULTS

Among 64 patients (112 eyes) observed from the point of addition of methotrexate to an anti–inflammatory regimen, 39.28%, 12.5%, 21.4%, 1.7%, 17.85%, and 7.14%, respectively, had anterior uveitis,  posterior or panuveitis, scleritis, ocular mucous membrane pemphigoid, and thyroid orbitopathy and non specific orbital inflammation. In these groups, complete suppression of inflammation sustained for ≥28 days was achieved within 6 months in 63.6%, 21.42%, 29.1%, 0%, 60%, and 37.5%, respectively. Corticosteroid–sparing success (sustained suppression of inflammation with prednisone ≤10 mg/d) was achieved within 6 months among 56.8%, 21.42%, 25%, 100%, 55%, and 37.5%, respectively. Overall, success within 12 months was 66% and 58.4% for sustained control and corticosteroid sparing ≤10 mg), respectively.

CONCLUSION Methotrexate is a well tolerated immunosuppressive medication which may benefit patients with recalcitrant non–infectious ocular and orbital inflammatory disease.