Objective

A non-interventional, longitudinal, retrospective follow-up study to assess CsA-induced nephrotoxicity (IN) and its reversibility after withdrawal in patients exhibiting a bilateral chronic posterior uveitis (CPU) associated with cystoid macular oedema (CMO) in at least one eye. Data from medical records between 1986 and 2013.

Methods

Primary outcome was the renal tolerance during and after CsA treatment assessed by plasma creatinine concentration and glomerular filtration rate (GFR) estimated by Chronic Kidney Disease Epidemiology (CKD-Epi) formula. Secondary outcomes were CsA through concentration, occurrence of cancers and ophthalmologic efficacy assessed by three parameters including CMO, vitreous inflammation, and best-corrected visual acuity BVCA changes.

Results

One hundred forty-three patients were followed for renal tolerance. Underlying diseases were Birdshot retinochoroiditis (n = 67), Behçet disease (n = 9), probable sarcoidosis (n = 23), sympathetic ophthalmia (n = 3), idiopathic (n = 41). After CsA discontinuation in 115 patients (mean treatment duration of 5.9 ± 3.8 years) mean plasma creatinine concentration was 82.2 ± 14.2 µmol/L versus 82.1 ± 14.1 µmol/L at baseline, mean GFR was 79.4 ± 13.9 mL/min versus 82.5 ± 14.3 mL/min at baseline, with no significant difference (respectively p = 0.91 and p = 0.09). Blood pressure did not significantly change during follow-up. CMO was completely resorbed in at least one eye, in 70.8% patients (n = 72) at 6 months, in 71.4% patients (n = 49) at 10 years and in 54.2% patients (n = 24) at 20 years. BCVA did not statistically change over time.

Conclusion

Early and long-term monitoring of renal tolerance and dual adjustment of CsA doses in inflammatory stages of CPU were associated with reversible CsA IN. CsA could be effective in the treatment of CMO in CPU patients.

中文翻译：

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环孢素 A 治疗与黄斑水肿相关的双侧自身免疫性慢性后葡萄膜炎：一项长期观察性安全性和有效性研究

客观的

一项非干预性、纵向、回顾性随访研究，以评估 CsA 诱导的肾毒性 (IN) 及其在至少一只眼睛中表现出与囊样黄斑水肿 (CMO) 相关的双侧慢性后葡萄膜炎 (CPU) 的患者停药后的可逆性. 来自 1986 年至 2013 年医疗记录的数据。

方法

主要结果是通过慢性肾脏病流行病学 (CKD-Epi) 公式估计的血浆肌酐浓度和肾小球滤过率 (GFR) 评估的 CsA 治疗期间和之后的肾脏耐受性。次要结果是 CsA 通过浓度、癌症发生率和通过三个参数评估的眼科疗效，包括 CMO、玻璃体炎症和最佳矫正视力 BVCA 变化。

结果

对 143 名患者的肾耐受性进行了随访。潜在疾病是 Birdshot 视网膜脉络膜炎 ( n  = 67)、Behçet 病 ( n  = 9)、可能的结节病 ( n  = 23)、交感性眼炎 ( n  = 3)、特发性 ( n  = 41)。115 名患者停用 CsA 后（平均治疗持续时间为 5.9 ± 3.8 年），平均血浆肌酐浓度为 82.2 ± 14.2 µmol/L，而基线时为 82.1 ± 14.1 µmol/L，平均 GFR 为 79.4 ± 13.9 mL/min vs 82.5 ± 14.3基线时的 mL/min，无显着差异（分别为p  = 0.91 和p = 0.09)。随访期间血压无明显变化。CMO 在至少一只眼睛中完全吸收，6 个月时 70.8% 的患者 ( n  = 72)，10 年时 71.4% 的患者 ( n  = 49) 和 20 年时 54.2% 的患者 ( n  = 24)。BCVA 没有随着时间的推移在统计上发生变化。

结论

在 CPU 的炎症阶段早期和长期监测肾脏耐受性和双重调整 CsA 剂量与可逆的 CsA IN 相关。CsA 可有效治疗 CPU 患者的 CMO。