Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study

This study will evaluate whether therapy that suppresses the immune system given to treat inflammatory diseases of the eye is associated with a greater risk of death and of cancer. Inflammatory diseases of the eye, including uveitis, scleritis, and mucous membrane pemphigoid, are major blinding diseases. For some patients, treatment with corticosteroids is not enough to control the diseases. Researchers expect to gain information about whether immunosuppressive therapy is suitable for patients and which substances should be avoided. Also, the study will evaluate the frequency of short-term complications with immunosuppressive therapy as well as benefits that the therapy can bring to treatment of eye diseases. The medical charts of patients up to age 65 (median age range of 21 to 65) who have had an inflammatory, noninfectious eye disease may be examined for this study. A database will be constructed through a chart review of patients seen in the uveitis clinic of the National Eye Institute since 1977 and three other sites. Patients who are considered exposed to immunosuppressive therapies will be compared with two groups: the general U.S. population and an internal group of patients with the same inflammatory eye diseases who did not receive immunosuppression. Data regarding about 10,000 to 15,000 patients will be collected. Patients will not be identified by the chart reviews. The incidence of cancer will be examined as well as the outcomes of immosuppressive therapy as measured by control of the eye disease, visual sharpness, changes in the use of corticosteroids, and rates of remission-when disease symptoms are lessened. Also examined will be medical charts of a control group of patients who did not receive immunosuppressive therapy for their uveitis. Data on cancer incidence would be more difficult to obtain, requiring personal contact with patients. In such situations, patients will be contacted by phone or mail, and those providing informed consent will be asked about their medical history, including previous occurrence of cancer and other conditions. For patients who have died, the researchers will attempt to communicate with the next of kin regarding this medical information.

Sex

All

* INCLUSION CRITERIA: Patients with the following diagnoses will be included:

Anterior uveitis;

Intermediate uveitis;

Posterior uveitis or panuveitis;

Scleritis;

Mucous membrane pemphigoid;

Other non-infectious ocular inflammatory disease.

EXCLUSION CRITERIA:

No ocular inflammatory disease;

Infectious ocular inflammatory disease (e.g. toxoplasmic retinitis, endophthalmitis, viral retinitis), unless the infectious uveitis followed treatment for a non-infectious ocular inflammatory disease.

• BACKGROUNDSantin M, Badrinas F, Mascaro J, Nolla JM, Pujol O, Roca G, Valverde J, Mana J, Fernandez-Nogues F. [Uveitis: an etiological study of 200 cases following a protocol]. Med Clin (Barc). 1991 May 4;96(17):641-4. Spanish. PMID 2056797
• DERIVEDBuchanich JM, Newcomb CW, Washington TL, Foster CS, Sobrin L, Thorne JE, Jabs DA, Suhler EB, Rosenbaum JT, Sen HN, Levy-Clarke GA, Nussenblatt RB, Bhatt NP, Lowder CY, Goldstein DA, Leiderman YI, Acharya NR, Holland GN, Read RW, Dunn JP, Dreger KA, Artornsombudh P, Begum HA, Fitzgerald TD, Kothari S, Payal AR, Daniel E, Gangaputra SS, Kacmaz RO, Liesegang TL, Pujari SS, Khachatryan N, Maghsoudlou A, Suga HK, Pak CM, Helzlsouer KJ, Kempen JH. Use of immunosuppression and subsequent cancer incidence: cohort study. BMJ Oncol. 2023 Aug 21;2(1):e000037. doi: 10.1136/bmjonc-2023-000037. eCollection 2023. PMID 39886503