Ten-year experience of pulsed intravenous cyclophosphamide and methylprednisolone protocol (PICM protocol) in severe ocular inflammatory disease.
AIMS
Severe ocular inflammation is a blinding ophthalmological emergency. This study evaluates the efficacy and patient tolerance of a validated regime of pulsed intravenous cyclophosphamide and methylprednisolone ('PICM protocol') for these patients.


METHODS
26 patients with severe inflammatory eye disease (43 eyes: 22 uveitis, 21 scleritis/sclerokeratitis; median age 52 years (IQR 40.25-62.25)) presenting to a regional tertiary referral centre were recruited over a 10-year period (January 2002-December 2011) into the PICM protocol, comprising intravenous cyclophosphamide 15 mg/kg, intravenous methylprednisolone 10 mg/kg, maximum nine pulses over 20 weeks supplemented with low-dose continuous oral prednisolone. Data were captured pretreatment and at 6 and 12 months follow-up. Primary outcome measures were control of inflammation according to standard criteria and reduction in systemic glucocorticoid to ≤10 mg prednisolone/day.


RESULTS
A median of six pulses (IQR 5-6) were administered over a median of 3 months (IQR 2.25-4). In the scleritis/sclerokeratitis group, 15/21(71%) achieved success or partial success at 6 and 12 months versus 9/22 (41%) for the same time points in the uveitis group (χ(2)=4.058, p=0.044). Two patients had adverse events requiring treatment withdrawal.


CONCLUSIONS
This PICM protocol is a well-tolerated regimen for managing severe ocular inflammation and appears particularly useful in patients with scleritis/sclerokeratitis.
['Khan|Imran J|IJ|', 'Barry|Robert J|RJ|', 'Amissah-Arthur|Kwesi N|KN|', 'Carruthers|David|D|', 'Elamanchi|Srinivasa Rao|SR|', 'Situnayake|Deva|D|', 'Murray|Philip I|PI|', 'Denniston|Alastair K|AK|', 'Rauz|Saaeha|S|']
D000328:Adult D000893:Anti-Inflammatory Agents D003520:Cyclophosphamide D004359:Drug Therapy, Combination D005260:Female D006801:Humans D007166:Immunosuppressive Agents D007262:Infusions, Intravenous D007634:Keratitis D008297:Male D008775:Methylprednisolone D008875:Middle Aged D015423:Scleritis D014605:Uveitis
Inflammation Cornea Retina Sclera and Episclera Treatment Medical