Efficacy of sulfasalazine on recurrent acute anterior uveitis: a three-year follow-up.

Abstract

Purpose: To evaluate the efficacy of sulfasalazine (SSZ) for recurrent acute anterior uveitis (AAU).

Methods: Retrospective chart review of patients diagnosed with recurrent AAU treated with SSZ from January 2008 to September 2023. The grading of uveitis activity was defined as per SUN working group. The primary outcome was the reduction in the number of uveitis flare-ups over a one-year, two-year and three year-period, compared to pre-treatment year. The response criteria to SSZ were defined as normal ophthalmologic examination. Paired samples Wilcoxon test and Kaplan-Meier survival curve were calculated using R-Commander statistical software (p < 0.05).

Results: Fifty-three patients were included. Mean time of follow up was 38.51 ± 38.45 months. Nine patients developed adverse effects to SSZ (16.98%) most of them mild. Ankylosing spondylitis was the most frequent association (n = 28, 52.83%), while HLA-B27 was positive in 69.23% of the patients (n = 36). The most frequent indication for SSZ was based on ocular activity in 52.83% (n = 28). The number of flare-ups dropped from 2.25 (± 1.34) in the pre-treatment year to, 0.81 (± 0.99) at year 1 (p < 0.001), 0.61 (± 0.78) at year 2 (p < 0.001) and 0.65 (± 0.83) at year 3 (p = 0.005). The median time to flare-up of AAU after SSZ was 15.13 months (CI 95, 7.97-27.40).

Conclusion: Our data point to sulfasalazine as an effective treatment to reduce flare-ups in patients with recurrent non-infectious AAU. Its low cost and good safety profile make it an interesting therapeutic alternative, especially in women of childbearing age.