Methotrexate, inflixamab and rituximab?

[jenny2008]

Does anyone know anything about the above drugs and if they help dry eye or hurt dry eye?? Please let me know.. thank you in advance!!!

[ringo]

Hi,

I hope that can be of help...I have asked a rheumatologist about them when I was at my worst. I was determined to be treated with these medications, as I was really desperate and at a very low point. This is what i remember he told me about them and persuaded me not to insist on trying the therapy:

These drugs are new biological agents,aimed at depleting and neutralizing specific immune cells from the bloodstream.

The drugs have been tested in trials and used in clinical practice for people with severe autoimmune disease and cancer. They have been known to help people with extreme cases of rheumatoid arthritis mainly. However, not without major adverse effects including extremely weakened immunity and other complications similar to being subjected to chemotherapy.

There are also reported cases of extreme reactions to these drugs, including Steven Johnson's syndrome.

In people with Sjogren's (dry eye-dry mouth) these drugs have shown minimal effects on the dryness, and unsatisfactory results overall.

The benefit of subjecting oneself to such a therapy should clearly exceed the risks involved, which means that the damage to the body has to be so great that all other means of treatment (systemic steroids, conventional immunosupressants like cyclopsorine and i mean oral and intravenous medications) have been proven futile in controlling the condition.

The rheumatologist I consulted when I was hospitalized because of the condition of my eyes, told me that doctors would not prescribe this therapy for treating dry eye because of the minimal effect on the dryness as weighed against the serious adverse effects.

Even in the most severe cases of dry eye, patients have been treated with other intravenous or oral immunosuppresants.
Also, these drugs are extremely expensive.

This information is a bit old, and doctors in the US might have already started treating severe dry eye with these agents. You should may be consult a specialist as well. Please let me know if you have any different feedback on the medications.

Thank you.

[indrep]

Jenny my wife takes methotrexate for her RA. While it helped her RA it did not stop her dry eye issues.

[nycdryeyegirl]

Does anyone know anything about the above drugs and if they help dry eye or hurt dry eye?? Please let me know.. thank you in advance!!!

Hi Jenny,

I found this article at www.ncbi.nim.nih.gov/pubmed .com. I hope you find the following information useful as it pertains to two of the following drugs (methotrexate and infliximib that you listed). According to this observational case study written by Drs. Cordero-Cma M, Anzaar F, Sobrin L, and Foster CS at the Massachusetts Eye Research & Surgery Institute, "systemic immunomodulatory therapy leads to significantly improved tear production and resolution of keratoconjunctivitis in these rare but severe cases"

I hope you find this article useful and informative. Pam.


Systemic immunomodulatory therapy in severe dry eye secondary to inflammation.
Cordero-Coma M, Anzaar F, Sobrin L, Foster CS.

Massachusetts Eye Research & Surgery Institute, Cambridge, MA 02142, USA.

PURPOSE: To report four patients with unusually severe acute keratitis sicca secondary to lacrimal tissue and ocular surface inflammation who eventually required systemic immunosuppressive therapy. METHODS: Observational case series of four patients with extremely severe acute dry eye syndrome who were profoundly disabled by pain and photophobia (to the extent of staying in dark rooms) despite aggressive conventional therapy. Clinical data including visual acuities, other treatments administered for dry eye, systemic medical conditions, Schirmer and rose bengal staining results, degree of conjunctival injection, and medications were recorded. All four patients were treated with systemic immunomodulatory therapy. RESULTS: All four patients were female with a mean age at presentation of 40 years (range 22-58 years), and all had systemic autoimmune diseases: systemic lupus erythematosus (SLE) and Sjogren's syndrome (n = 2), Sjogren's syndrome (n = 1), rheumatoid arthritis (RA) and psoriasis (n = 1). Schirmer test values at onset ranged from 0 to 2 mm. All patients had failed aggressive lubrication, topical cyclosporine, lid care, and punctual plugs. In two patients, serum tears and hyphrecation punctal occlusion were tried without success. Various systemic immunosuppressive agents were used to control inflammation of the lacrimal glands: methotrexate and cyclosporine A (patient 1), cyclosporine A (patient 2), prednisone (patient 3), and methotrexate and infliximab (patient 4). Treatment with systemic immunomodulatory agents resulted in resolution of the acute inflammatory assault on the lacrimal glands and control of signs and symptoms of keratoconjunctivitis sicca in all four patients, and visual acuities improved in all of them. Post-treatment Schirmer values ranged from 7 to 10 mm. CONCLUSION: Systemic immunosuppressive agents may be required in the treatment of recalcitrant primary and secondary Sjogren's syndrome caused by systemic autoimmune conditions. We show that systemic immunomodulatory therapy leads to significantly improved tear production and resolution of the keratoconjunctivitis in these rare but severe cases.

[jenny2008]

thanks for this info.. i really appreciate it