Smith J R, Rosenbaum J T
Casey Eye Institute, Oregon Health Sciences University, Portland, Oregon 97201-4197, USA.
Br J Ophthalmol. 2001 Oct;85(10):1220-4. doi: 10.1136/bjo.85.10.1220.
To evaluate the clinical usefulness of methotrexate for patients with non-infectious orbital inflammatory disease who fail to respond to systemic corticosteroids and/or orbital irradiation.
The medical records of patients with non-infectious orbital inflammatory disease who were treated with methotrexate at Oregon Health Sciences University between June 1993 and June 2000 were examined. 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 orbital inflammation, visual acuity, dosage and duration of methotrexate therapy, requirement for concurrent corticosteroid administration, and adverse drug reactions were recorded.
The study cohort included 14 patients (24 eyes) with diagnoses including non-specific orbital inflammation (n=7), Tolosa-Hunt syndrome (n=1), thyroid orbitopathy (n=3), Wegener's granulomatosis (n=1), sarcoidosis (n=1), and Erdheim-Chester disease (n=1). In all cases, methotrexate was commenced as a corticosteroid sparing agent. 10 patients (71%) completed a 4 month therapeutic trial of methotrexate. Median duration of treatment for the nine (64%) patients who experienced clinical benefit was 25 months (range 10-47 months). Six responders were ultimately able to cease methotrexate, including the single patient who required concurrent long term corticosteroid therapy. Complications included fatigue, gastrointestinal disturbance, hair thinning and mild, reversible serum liver enzyme elevation. Two patients (14%) discontinued treatment because of adverse effects.
Methotrexate is a well tolerated immunosuppressive medication which may benefit patients with recalcitrant non-infectious orbital inflammatory disease.
评估甲氨蝶呤对系统性皮质类固醇激素和/或眼眶照射治疗无效的非感染性眼眶炎性疾病患者的临床疗效。
查阅1993年6月至2000年6月在俄勒冈健康科学大学接受甲氨蝶呤治疗的非感染性眼眶炎性疾病患者的病历。甲氨蝶呤的中位最大剂量为每周20毫克（范围为每周15 - 25毫克），同时补充叶酸。对患者进行定期眼科检查、血清肝酶水平和血细胞计数监测。记录眼眶炎症消退的临床体征、视力、甲氨蝶呤治疗的剂量和持续时间、同时使用皮质类固醇激素的需求以及药物不良反应。
研究队列包括14例患者（24只眼），诊断包括非特异性眼眶炎症（n = 7）、托洛萨 - 亨特综合征（n = 1）、甲状腺相关性眼病（n = 3）、韦格纳肉芽肿病（n = 1）、结节病（n = 1）和厄尔德海姆 - 切斯特病（n = 1）。在所有病例中，甲氨蝶呤作为一种减少皮质类固醇激素用量的药物开始使用。10例患者（71%）完成了为期四个月的甲氨蝶呤治疗试验。9例（64%）有临床获益的患者的中位治疗持续时间为25个月（范围为10 - 47个月）。6例有反应的患者最终能够停用甲氨蝶呤，包括1例需要长期同时使用皮质类固醇激素治疗的患者。并发症包括疲劳、胃肠道不适、头发稀疏和轻度、可逆性血清肝酶升高。2例患者（14%）因不良反应停药。
甲氨蝶呤是一种耐受性良好的免疫抑制药物，可能使顽固性非感染性眼眶炎性疾病患者获益。
