Interferon therapy is superior to methotrexate for uveitis

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1. Visual acuity improvement was much higher with interferon beta therapy compared to methotrexate therapy (p=0.0435).

2. Macular thickness was significantly decreased in patients treated with interferon beta (p=0.0039), but increased in patients treated with methotrexate.

Evidence Rating Level: 1 (Excellent)

Study Rundown: This study demonstrates the increased efficacy of interferon (IFN) beta treatment over therapy with methotrexate (MTX) for uveitis and macular edema. The fact that the study had to be terminated early demonstrates the superiority of IFN beta therapy. These findings have great value, as intermediate uveitis with macular edema is often unresponsive to immunosuppressive therapy, necessitating the use of other agents. Studying the efficacy of IFN beta in treating uveitis is also useful to clinicians, as IFN beta is a mainstay treatment for multiple sclerosis, which often manifests with uveitis. There were a few significant limitations to the study. Most importantly, this study featured a small sample size, making it difficult to generalize the findings. In addition, it is challenging to comment on the superiority of IFN beta treatment specifically in multiple sclerosis patients, as almost all of these patients were in the MTX treatment group. However, the impressive difference in outcome measures between the two groups indicates that this finding is likely to be replicated in a larger randomized trial.

Click to read the study in American Journal of Ophthalmology

Relevant Reading: Interferons and their potential in the treatment of ocular inflammation

In Depth: In this small randomized controlled trial, patients with confirmed intermediate uveitis accompanied by macular edema were divided into two treatment groups. The control group received methotrexate (MTX), the current standard of care, while the treatment group received interferon (IFN) beta. Visual acuity and macular thickness were measured prior to start of therapy and three months after therapy. At three months, patients in the IFN beta group had an improvement of 15.6 letters on the ETDRS reading chart (p=0.0039) compared to an improvement of 4.7 letters (p=0.1309) in the MTX group; the difference in the magnitude of improvement between the two groups was statistically significant (p=0.0435). Macular thickness decreased by 206 µm (p=0.0039) in the IFN beta group, but increased by 47 µm (p=0.0781) in the MTX group, leading to a significant difference between the two groups (p<0.0001). Patients who switched from MTX to IFN beta at the three-month mark had a significant improvement in visual acuity at the termination of the study. The improvement in visual acuity and resolution of macular thickness continued in the IFN beta group up to the one-year study end.

By Swarup Swaminathan and Andrew Bishara

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