Cutting back on the medical regimen for your scleritis patients after a period of time may be warranted, since remission was found in a majority of patients after three years, a study in the American Journal of Ophthalmology reports.

This retrospective cohort study was conducted at four ocular inflammation subspecialty centers where data was collected for each patient at every visit from the individual center’s inception (1978, 1978, 1984 and 2005, respectively) up until 2010. The study defined remission as inactivity of the disease when patients were off all suppressive medications for three consecutive months or at all visits up to the last visit—to avoid censoring patients from stopping follow-up after remission, the study noted.  

The investigation included 825 eyes, and researchers reported remission occurred in 399 eyes (299 of 588 patients). The study also found median remission time was approximately three years, and more instances occurred earlier rather than later during the follow-up.

Researchers cited patients with lower remission rates had bilateral scleritis or a coexisting systemic inflammatory disease, such as rheumatoid arthritis, granulomatosis with polyangiitis or systemic lupus erythematosus.

Patients who had angiotensin-converting enzyme (ACE) inhibitor treatment within 90 or less days had a greater incidence of remission, the researchers noted in their paper.

The results suggest remission occurred in most scleritis patients within slightly more than three years—less than newly diagnosed anterior uveitis but more than intermediate uveitis—which may mean periodic attempts at tapering suppressive medications could be warranted, investigators said. Remission was less frequently achieved when systemic inflammatory diseases were present. Confirmatory studies of whether adjunctive ACE inhibitor or statin treatment truly can enhance scleritis remission are needed, they added.

Kempen JH, Pistilli M, Begum H, et al. Remission of non-infectious anterior scleritis: incidence and predictive factors. Am J Ophthalmol. April 3, 2019. [Epub ahead of print].