Abstract
Background:
Scleritis is a severe, painful inflammatory condition affecting the sclera. If untreated, scleritis can lead to significant ocular complications. Corticosteroids are often considered for the initial treatment of non-infectious scleritis. However, for steroid-resistant cases, cases requiring prolonged therapy, or to reduce steroid dependence, immunosuppressive agents, including methotrexate (MTX), are employed.
Objectives:
This study compared the efficacy and safety of MTX versus steroids and placebo in treating scleritis.
Methods:
A comprehensive literature search was conducted via different databases. The search results were screened against prespecified eligibility criteria. The risk of bias in the included studies was appraised using the Newcastle-Ottawa Quality Scale and the risk of bias in nonrandomized studies with intervention (ROBINS-I). Data were then systematically extracted and analyzed.
Results:
The literature search yielded 558 records, of which 11 studies that met the eligibility criteria were included. MTX in scleritis treatment demonstrated significant efficacy for inflammation control (P = 0.003). However, its effect on visual acuity was insignificant (P = 0.689). Safety analysis revealed lower adverse event rates than azathioprine and insignificant differences with mycophenolate, with comparable discontinuation rates. Treatment response varies by scleritis subtype, with higher efficacy in non-necrotizing anterior scleritis.
Conclusion:
The study revealed MTX’s clinical significance in managing noninfectious scleritis. Significant results were observed in inflammation control and tolerability; however, the lack of randomized comparator studies limits conclusions regarding MTX’s superiority over steroids or placebo. Future controlled trials are needed to confirm comparative effectiveness and refine treatment guidelines.
Keywords
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