Systemic immunosuppressive therapy in idiopathic non-infectious uveitis and scleritis: disease remission, discontinuation, and relapse patterns.

backgroundImmunosuppressive therapy (IST) is indicated in idiopathic non-infectious uveitis and scleritis when local or topical treatments are insufficient, but long-term outcomes and predictors of relapse remain incompletely defined.

methodsWe retrospectively reviewed clinical records of 110 patients with non-infectious uveitis or scleritis in the absence of systemic manifestation of disease who received IST. Time to remission, treatment duration, and relapse after IST withdrawal were analyzed by anatomic subtype. Predictors of remission and relapse were assessed using multivariable Cox and logistic regression models.

resultsMedian follow-up was 84 months (IQR 48-135). Most patients achieved remission with first-line IST (79%), Methotrexate predominated in anterior (n = 27, 90%), intermediate (n = 13, 93%), and scleritis (n = 11, 85%), whereas cyclosporine was preferred in posterior (n = 20, 65%) and panuveitis (n = 12, 54%). Biological therapy (adalimumab) was used infrequently (n = 8, 7%). Median time to remission was 7 months (IQR 3.1-12.5), although posterior uveitis required significantly longer to remit (median 11 months; HR = 0.45 vs. AU, p = 0.005). Need for concomitant low-dose corticosteroids (≤10 mg/day) to achieve remission was associated with delayed remission (HR = 0.55, p = 0.006). IST was discontinued in 47% of patients, most commonly after ≥ 2 years due to disease control, while early discontinuation (< 2 years) was primarily due to adverse effects. Relapse occurred in 27% after withdrawal, typically within 10 months. Univariate analysis suggested differences by subtype, but only longer time to remission (p = 0.018) and shorter IST duration (p < 0.05) independently predicted relapse in multivariable models.

conclusionsIST effectively induced remission and reduced relapse rates in ocular-only non-infectious inflammation. Achieving early control (within six months) and maintaining IST for at least two years were associated with more durable remission. Posterior involvement and the need for concomitant low-dose oral corticosteroids reflected greater disease severity, whereas delayed remission and shorter IST duration independently predicted relapse.