51
|
Abstract
Juvenile idiopathic arthritis (JIA)-associated uveitis is an intriguing manifestation of JIA and an important contributor of long-term damage. Its pathophysiology is still poorly understood. This review summarizes current concepts. JIA is both a multifactorial and polygenetic disease. In the past 2 decades, multiple studies have indicated that the genetic contribution to both JIA and JIA-associated uveitis is modest. From an ophthalmological point of view, much of the pathophysiological data is derived from studies in experimental uveitis animal models. The pathophysiology of the arthritic manifestations of JIA has been studied extensively in humans. These studies have focused on the principal cells of the adaptive immune system, in particular different subsets of regulatory and effector T cells, as well as on antigen presenting cells or dendritic cells. With advancing technology and advancing knowledge of the underlying mechanisms of JIA-associated uveitis, new targets for therapy might evolve in the coming years.
Collapse
Affiliation(s)
- Sebastiaan J Vastert
- Department of Pediatric Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht , The Netherlands and
| | | | | |
Collapse
|
52
|
Simonini G, Druce K, Cimaz R, Macfarlane GJ, Jones GT. Current Evidence of Anti-Tumor Necrosis Factor α Treatment Efficacy in Childhood Chronic Uveitis: A Systematic Review and Meta-Analysis Approach of Individual Drugs. Arthritis Care Res (Hoboken) 2014; 66:1073-84. [DOI: 10.1002/acr.22214] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 10/15/2013] [Indexed: 12/14/2022]
|
53
|
Myers AC, Ghosh F, Andréasson S, Ponjavic V. Retinal function and morphology in the rabbit eye after intravitreal injection of the TNF alpha inhibitor adalimumab. Curr Eye Res 2014; 39:1106-16. [PMID: 24897597 PMCID: PMC4238743 DOI: 10.3109/02713683.2014.898309] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aim To study the effects of the tumor necrosis factor alpha inhibitor adalimumab on rabbit retina after injection into the vitreous body. Methods Forty-eight rabbits of mixed strain (9–12 months old, weighing ≈ 3.5 kg) were randomized into four groups. Adalimumab was injected at one of two concentrations (1.25 mg or 2.5 mg) into the eyes of two groups, and balanced salt solution into the eyes of the third group. The fourth group acted as controls. Full-field electroretinography (ffERG) was performed before injection and 1 and 6 weeks post-injection. At 6 weeks post-injection the rabbits were euthanized and the sectioned retinas were studied. Retinal histology was studied with hematoxylin–eosin staining. Immunohistochemical analysis was performed on rods, cones, rod bipolar cells, horizontal cells, amacrine cells and Müller cells. Results No significant difference in ffERG amplitudes or implicit times was observed between the four groups at any time point. Histological and immunohistochemical findings were similar in all groups. Conclusions Injection of adalimumab into the vitreous body of healthy rabbits, at doses up to 2.5 mg, does not appear to be toxic to the rabbit retina.
Collapse
|
54
|
Insights Into Uveitis in Association With Spondyloarthritis From a Large Patient Survey. J Clin Rheumatol 2014; 20:141-5. [DOI: 10.1097/rhu.0000000000000087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
55
|
Levy-Clarke G, Jabs DA, Read RW, Rosenbaum JT, Vitale A, Van Gelder RN. Expert Panel Recommendations for the Use of Anti–Tumor Necrosis Factor Biologic Agents in Patients with Ocular Inflammatory Disorders. Ophthalmology 2014; 121:785-96.e3. [DOI: 10.1016/j.ophtha.2013.09.048] [Citation(s) in RCA: 327] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 09/24/2013] [Accepted: 09/30/2013] [Indexed: 12/14/2022] Open
|
56
|
Leukocyte production of inflammatory mediators is inhibited by the antioxidants phloretin, silymarin, hesperetin, and resveratrol. Mediators Inflamm 2014; 2014:938712. [PMID: 24707119 PMCID: PMC3953573 DOI: 10.1155/2014/938712] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/09/2014] [Accepted: 01/11/2014] [Indexed: 12/18/2022] Open
Abstract
Antioxidants possess significant therapeutic potential for the treatment of inflammatory disorders. One such disorder is periodontitis characterised by an antimicrobial immune response, inflammation, and irreversible changes to the supporting structures of the teeth. Recognition of conserved pathogen-associated molecular patterns is a crucial component of innate immunity to Gram-negative bacteria such as Escherichia coli, as well as the periodontal pathogen Aggregatibacter actinomycetemcomitans. In this study, we investigated the antioxidants Phloretin, Silymarin, Hesperetin, and Resveratrol to ascertain whether they altered the production of inflammatory mediators by innately-activated leukocytes. Peripheral blood mononuclear cells were stimulated with lipopolysaccharide purified from Aggregatibacter actinomycetemcomitans, and the production of cytokines, chemokines, and differentiation factors was assayed by enzyme-linked immunosorbent assay, cytometric bead array, and RT-PCR. Significant inhibition of these factors was achieved upon treatment with Phloretin, Silymarin, Hesperetin, and Resveratrol. These data further characterise the potent anti-inflammatory properties of antioxidants. Their ability to inhibit the production of inflammatory cytokines, chemokines, and differentiation factors by a heterogeneous population of leukocytes has clear implications for their therapeutic potential in vivo.
Collapse
|
57
|
Rifkin LM, Birnbaum AD, Goldstein DA. TNF inhibition for ophthalmic indications: current status and outlook. BioDrugs 2014; 27:347-57. [PMID: 23568177 DOI: 10.1007/s40259-013-0022-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Tumor necrosis factors (TNF) are a group of cytokines that play a role in systemic inflammation, stimulating the acute phase reaction. They are involved in systemic rheumatologic conditions such as rheumatoid arthritis and juvenile idiopathic arthritis, as well as ocular inflammatory conditions in the uveitis spectrum. Several drugs were developed to inhibit the action of TNF, thereby reducing inflammation. The three most commonly used TNF inhibitors in the US are etanercept, infliximab, and adalimumab. Newer drugs include certolizumab and golimumab. In this review, we discuss the differences in the mechanism of action, route of administration, indication, and efficacy of TNF inhibitors used in the treatment of ocular inflammation. METHODS A review of the literature in the PubMed, MEDLINE, and Cochrane databases was conducted to identify clinical trials, comparative studies, case series, and case reports describing the use of tumor necrosis factor inhibitors in uveitis therapy. The search was limited to primary reports published in English with human subjects from 1990 to the present, yielding 5,238 manuscripts. In addition, referenced articles from the initial searches were hand searched to identify additional relevant reports. After title and abstract selection, duplicate elimination, and manual search, 69 papers were selected for analysis. Exclusion criteria included review articles and case reports on the efficacy of etanercept, infliximab, and adalimumab. Manuscripts with fewer than 20 study subjects were excluded if other larger studies existed on the use of the same drug for a particular indication. Studies with <6 months of patient follow-up were also excluded, except in the case where no other data were available. Articles meeting these criteria were then reviewed by the three authors for inclusion in this review. RESULTS Tumor necrosis factor inhibitors have been shown to decrease inflammation associated with a number of rheumatologic conditions. Three of the five commercially available TNF inhibitors-etanercept, infliximab, and adalimumab-have been studied for their efficacy in treatment of ocular inflammation. Etanercept appears to be inadequate in controlling ocular inflammation and is not recommended for the treatment of uveitis. Infliximab and adalimumab, however, have shown encouraging results in multiple trials. Serious potential side effects such as infection, including reactivation of latent tuberculosis, malignancy, and demyelinating disease, may limit the use of TNF inhibitors in uveitis. Proper screening of patients prior to initiating these therapies may decrease these risks. DISCUSSION Early success with infliximab and adalimumab has paved the way for new TNF inhibitors and other corticosteroid-sparing drugs to emerge in the treatment of ocular inflammation. Future studies are on the horizon to determine the long-term safety and efficacy of newer TNF inhibitors such as certolizumab and golimumab.
Collapse
Affiliation(s)
- Lana M Rifkin
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | | | | |
Collapse
|
58
|
Pasadhika S, Rosenbaum JT. Update on the use of systemic biologic agents in the treatment of noninfectious uveitis. Biologics 2014; 8:67-81. [PMID: 24600203 PMCID: PMC3933243 DOI: 10.2147/btt.s41477] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Uveitis is one of the leading causes of blindness worldwide. Noninfectious uveitis may be associated with other systemic conditions, such as human leukocyte antigen B27-related spondyloarthropathies, inflammatory bowel disease, juvenile idiopathic arthritis, Behçet’s disease, and sarcoidosis. Conventional therapy with corticosteroids and immunosuppressive agents (such as methotrexate, azathioprine, mycophenolate mofetil, and cyclosporine) may not be sufficient to control ocular inflammation or prevent non-ophthalmic complications in refractory patients. Off-label use of biologic response modifiers has been studied as primary and secondary therapeutic agents. They are very useful when conventional immunosuppressive therapy has failed or has been poorly tolerated, or to treat concomitant ophthalmic and systemic inflammation that might benefit from these medications. Biologic therapy, primarily infliximab, and adalimumab, have been shown to be rapidly effective for the treatment of various subtypes of refractory uveitis and retinal vasculitis, especially Behçet’s disease-related eye conditions and the uveitis associated with juvenile idiopathic arthritis. Other agents such as golimumab, abatacept, canakinumab, gevokizumab, tocilizumab, and alemtuzumab may have great future promise for the treatment of uveitis. It has been shown that with proper monitoring, biologic therapy can significantly improve quality of life in patients with uveitis, particularly those with concurrent systemic symptoms. However, given high cost as well as the limited long-term safety data, we do not routinely recommend biologics as first-line therapy for noninfectious uveitis in most patients. These agents should be used with caution by experienced clinicians. The present work aims to provide a broad and updated review of the current and in-development systemic biologic agents for the treatment of noninfectious uveitis.
Collapse
Affiliation(s)
- Sirichai Pasadhika
- Department of Ophthalmology, Southern Arizona Veterans Administration Health Care System, Tucson, AZ, USA
| | | |
Collapse
|
59
|
Comparison of Acute Effect of Systemic Versus Intravitreal Infliximab Treatment in an Experimental Model of Endotoxin-Induced Uveitis. J Ocul Pharmacol Ther 2014; 30:74-80. [DOI: 10.1089/jop.2012.0238] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
60
|
Valério Sequeira Valadares J, Bastos-Carvalho A, Pedroso Franco JM, Mourão AF, Monteiro-Grillo M. Phlyctenular keratoconjunctivitis - an atypically severe case treated with systemic biologic immunosuppressive therapy. GMS OPHTHALMOLOGY CASES 2014; 4:Doc02. [PMID: 27625937 PMCID: PMC5015615 DOI: 10.3205/oc000015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To report an atypically severe and refractory phlyctenular keratoconjunctivitis case treated successfully with systemic biologic immunosuppressive therapy. METHODS A 10-year-old female was followed in the ophthalmology clinic for three years for a severe form of bilateral PKC. The patient was treated for blepharitis and intestinal parasitosis, and underwent topical corticosteroid therapy, followed by subconjunctival injections and systemic corticosteroids with no clinical improvement. An association of topical cyclosporine A and oral methotrexate had no clinical response either. Phlyctenae of the cornea remained evident with neovascularization, progressive peripheral corneal thinning and occasional anterior chamber reaction. RESULTS The patient was treated with a combination of infliximab and methotrexate and corticosteroid therapy was tapered, with a fast and sustained resolution of the symptoms and corneal signs. Eleven months past initiation of the treatment, the patient remains asymptomatic and without any recurrence of the disease. CONCLUSION Phlyctenular keratoconjunctivitis may present with a broad spectrum of symptoms and signs, and its severity varies significantly. In cases of severe PKC, which are refractory to conventional therapy, systemic biologic immunosuppressive therapy may be a valuable alternative.
Collapse
Affiliation(s)
- Joana Valério Sequeira Valadares
- Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisbon, Portugal,*To whom correspondence should be addressed: Joana Valério Sequeira Valadares, Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal, E-mail:
| | | | | | - Ana Filipa Mourão
- Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisbon, Portugal,Centro Hospitalar Lisboa Ocidental, Egas Moniz Hospital, Lisbon, Portugal
| | - Manuel Monteiro-Grillo
- Department of Ophthalmology, Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisbon, Portugal
| |
Collapse
|
61
|
|
62
|
|
63
|
|
64
|
Angeles-Han ST, Pelajo CF, Vogler LB, Rouster-Stevens K, Kennedy C, Ponder L, McCracken C, Lopez-Benitez J, Drews-Botsch C, Prahalad S. Risk markers of juvenile idiopathic arthritis-associated uveitis in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. J Rheumatol 2013; 40:2088-96. [PMID: 24187099 DOI: 10.3899/jrheum.130302] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To characterize the epidemiology and clinical course of children with juvenile idiopathic arthritis-associated uveitis (JIA-U) in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry and explore differences between African American (AA) and non-Hispanic white (NHW) children. METHODS There were 4983 children with JIA enrolled in the CARRA Registry. Of those, 3967 NHW and AA children were included in this study. Demographic and disease-related data were collected from diagnosis to enrollment. Children with JIA were compared to those with JIA-U. Children with JIA-U were also compared by race. RESULTS There were 459/3967 children (11.6%) with JIA-U in our cohort with a mean age (SD) of 11.4 years (± 4.5) at enrollment. Compared to children with JIA, they were younger at arthritis onset, more likely to be female, had < 5 joints involved, had oligoarticular JIA, and were antinuclear antibody (ANA)-positive, rheumatoid factor (RF)-negative, and anticitrullinated protein antibody-negative. Predictors of uveitis development included female sex, early age of arthritis onset, and oligoarticular JIA. Polyarticular RF-positive JIA subtype was protective. Nearly 3% of children with JIA-U were AA. However, of the 220 AA children with JIA, 6% had uveitis; in contrast, 12% of the 3721 NHW children with JIA had uveitis. CONCLUSION In the CARRA registry, the prevalence of JIA-U in AA and NHW children is 11.6%. We confirmed known uveitis risk markers (ANA positivity, younger age at arthritis onset, and oligoarticular JIA). We describe a decreased likelihood of uveitis in AA children and recommend further exploration of race as a risk factor in a larger population of AA children.
Collapse
Affiliation(s)
- Sheila T Angeles-Han
- From the Department of Pediatrics, and Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Pediatric Rheumatology, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts; and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
65
|
Dragnev D, Barr D, Kulshrestha M, Shanmugalingam S. Sarcoid panuveitis associated with etanercept treatment, resolving with adalimumab. BMJ Case Rep 2013; 2013:bcr-2013-200552. [PMID: 24005973 DOI: 10.1136/bcr-2013-200552] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We presented a case of a 54-year-old woman, who developed sarcoidosis uveitis while on treatment with the tumour necrosis factor α (TNFα) antagonist etanercept for rheumatoid arthritis. Her condition improved, but did not recover completely after the medication was stopped. After starting her on another TNFα antagonist, adalimumab, the uveitis recovered completely. Etanercept and adalimumab are from the same class of medication, but have different effects on other mediators and cells, which may explain these discrepancies.
Collapse
Affiliation(s)
- D Dragnev
- Hywel Dda Health Board, Aberystwyth Eye Centre, Aberystwyth, UK.
| | | | | | | |
Collapse
|
66
|
Teoh SC, Dick AD. Diagnostic techniques for inflammatory eye disease: past, present and future: a review. BMC Ophthalmol 2013; 13:41. [PMID: 23926885 PMCID: PMC3750647 DOI: 10.1186/1471-2415-13-41] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 08/01/2013] [Indexed: 12/14/2022] Open
Abstract
Investigations used to aid diagnosis and prognosticate outcomes in ocular inflammatory disorders are based on techniques that have evolved over the last two centuries have dramatically evolved with the advances in molecular biological and imaging technology. Our improved understanding of basic biological processes of infective drives of innate immunity bridging the engagement of adaptive immunity have formed techniques to tailor and develop assays, and deliver targeted treatment options. Diagnostic techniques are paramount to distinguish infective from non-infective intraocular inflammatory disease, particularly in atypical cases. The advances have enabled our ability to multiplex assay small amount of specimen quantities of intraocular samples including aqueous, vitreous or small tissue samples. Nevertheless to achieve diagnosis, techniques often require a range of assays from traditional hypersensitivity reactions and microbe specific immunoglobulin analysis to modern molecular techniques and cytokine analysis. Such approaches capitalise on the advantages of each technique, thereby improving the sensitivity and specificity of diagnoses. This review article highlights the development of laboratory diagnostic techniques for intraocular inflammatory disorders now readily available to assist in accurate identification of infective agents and appropriation of appropriate therapies as well as formulating patient stratification alongside clinical diagnoses into disease groups for clinical trials.
Collapse
Affiliation(s)
- Stephen C Teoh
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
| | | |
Collapse
|
67
|
Takeuchi M. A systematic review of biologics for the treatment of noninfectious uveitis. Immunotherapy 2013; 5:91-102. [PMID: 23256801 DOI: 10.2217/imt.12.134] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Noninfectious uveitis is a potentially sight-threatening ocular disorder and variable therapeutic strategies have been proposed. Biologic therapies were introduced as a new option for patients with uveitis refractory to the conventional therapy using corticosteroids and immunosuppressive agents, and 10 years have passed since the initiation. In this review, the author summarizes current articles on the assessment of therapeutic application of biologics for refractory uveitis including other autoimmune diseases. Although some results are based on investigation with insufficient clinical trials, especially in biologics, the majority of biologics indicate preferable outcomes on refractory uveitis, with remarkable promise to increase the possibility of long-term remissions.
Collapse
Affiliation(s)
- Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, Saitama, Japan.
| |
Collapse
|
68
|
Mesquida M, Molins B, Llorenç V, Hernández MV, Espinosa G, Dick AD, Adán A. Current and future treatments for Behçet's uveitis: road to remission. Int Ophthalmol 2013; 34:365-81. [PMID: 23729309 DOI: 10.1007/s10792-013-9788-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 05/02/2013] [Indexed: 12/14/2022]
Abstract
Behçet's disease (BD) is a multisystem inflammatory disorder of uncertain origin, although it remains defined within the spectrum of systemic immune-mediated vasculitic disorders and also represents a spectrum of putative autoimmune disease. Major symptoms include oral aphthous ulcers, genital ulcerations, skin lesions, and ocular lesions. Despite afflicting many systems, ocular complications of BD are some of the more devastating for the patient and their quality of life. Eye involvement, which affects 60-80 % of BD patients, is characterized in its more severe form by posterior or panuveitis including occlusive retinal vasculitis. While pathogenesis of BD remains complex, association with Class I MHC (HLA-B*51) predisposing to inflammation with engagement of the innate-immune system (neutrophils, NK cells), and perpetuated by the adaptive T cell responses against infectious- and/or auto-antigens. Despite the choice of conventional immunosuppressive therapies available, only recently with the advent of biologic therapy has visual prognosis and outcomes been substantially and favorably altered. For example, both interferon-α (IFN-α) and tumour necrosis factor (TNF)-α antagonists deliver promising results and for the first time improve prognosis. With IFN-α therapy, durable remissions of uveitis can be achieved and lead to drug-free remission. Similarly, anti-TNF therapy with infliximab is reported to be rapidly effective in inducing and maintaining remission. Most recently, rising evidence reports on the use of adalimumab, etanercept, and golimumab, while use of anti-interleukin (IL)-1 agents (anakinra, canakinumab, gevokizumab), IL-6 blockers (tocilizumab), and rituximab (depleting anti-CD20 antibody) is also increasing. The aim of this review is to provide evidence for the role of conventional therapies combined with evidence for advantages and disadvantages of biologic therapies in the treatment of ocular BD. Although randomized controlled trials remain sparse, evidence remains strong and enticing that biologic agents are invaluable for the treatment of sight-threatening Behçet's uveitis and makes it an exciting time for Behçet's specialists worldwide.
Collapse
Affiliation(s)
- Marina Mesquida
- Ophthalmology Department, Hospital Clinic of Barcelona, University of Barcelona, Sabino de Arana, 1, 08028, Barcelona, Spain,
| | | | | | | | | | | | | |
Collapse
|
69
|
Abstract
Relapsing ocular involvement is one of the major manifestations in Behçet disease (BD). When ocular BD is left untreated, it often results in blindness in <5 years. Combining systemic corticosteroids with cyclosporine A and other conventional immune modulating agents has been the only choice for treatment. More recently, the introduction of 'biologics' seems to be an effective therapy in patients affected with BD, especially in those with ocular disease. Our purpose was to survey the current knowledge regarding the biological therapeutic approaches for Behçet uveitis. We focused on the most commonly used biological agents: 'tumor necrosis factor-alpha antagonists' and 'interferon alpha'. We attempted to compare the effectiveness of these two biologicals and tried to balance on the pros and cons of these agents in clinical practice. The impressive efficacy of both approaches in sight-threatening BD argues for their expanding role. Earlier introduction of these agents in the course of disease may prevent irreversible structural damage and may result in improved long-term prognosis.
Collapse
Affiliation(s)
- Dicle Hazirolan
- Department of Ophthalmology, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey
| | | | | |
Collapse
|
70
|
Biotherapies in inflammatory ocular disorders: Interferons, immunoglobulins, monoclonal antibodies. Autoimmun Rev 2013; 12:774-83. [DOI: 10.1016/j.autrev.2013.02.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 02/18/2013] [Indexed: 12/12/2022]
|
71
|
Giuliari GP, Sadaka A, Hinkle DM. Biologic agents in experimental autoimmune uveitis. Int Ophthalmol 2013; 34:145-56. [PMID: 23494482 DOI: 10.1007/s10792-013-9756-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 03/04/2013] [Indexed: 12/18/2022]
Abstract
Experimental uveitis models were developed in an effort to elucidate the pathogenesis of human uveitis. The therapeutic effects of numerous anti-inflammatory agents including corticosteroids and immunomodulatory agents including biologic response modifiers have been investigated in both experimental and human uveitis. Monoclonal antibodies to tumor necrosis factor alpha and anti-interleukins, among others, demonstrate efficacy and are employed in the treatment of uveitis refractory to conventional immunomodulatory agents.
Collapse
|
72
|
Wakefield D, Di Girolamo N, Thurau S, Wildner G, McCluskey P. Scleritis: Immunopathogenesis and molecular basis for therapy. Prog Retin Eye Res 2013; 35:44-62. [PMID: 23454614 DOI: 10.1016/j.preteyeres.2013.02.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 02/10/2013] [Accepted: 02/15/2013] [Indexed: 12/19/2022]
Abstract
Scleritis is a heterogeneous group of diseases characterized by inflammation of the sclera, which may be due to local or systemic infections or immune mediated diseases. Numerous studies over the last decade have lead to significant progress in understanding the pathogenesis and treatment of this severe and potentially blinding disease. Immunological investigations of non-infectious scleritis and associated diseases have indicated that scleritis is an autoimmune disease and studies on the nature of the local inflammatory response have revealed the prominent role of T and B cells and cytokines, such as TNF-alpha, which in turn has resulted in clinical trials showing the effectiveness of local steroid treatment, anti-TNF and anti-B cell therapy. The widespread use of imaging has led to the realization that posterior scleritis is more common than previously recognized and testing for ANCA antibodies has revealed the prominent role of immune mechanisms in a subset of patients with scleritis and associated systemic vasculitis.
Collapse
Affiliation(s)
- Denis Wakefield
- School of Medical Sciences, UNSW Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | | | | | | | | |
Collapse
|
73
|
Cordero-Coma M, Yilmaz T, Onal S. Systematic Review of Anti-Tumor Necrosis Factor-alpha Therapy for Treatment of Immune-mediated Uveitis. Ocul Immunol Inflamm 2013; 21:19-27. [DOI: 10.3109/09273948.2012.723107] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
74
|
|
75
|
|
76
|
Heo J, Sepah YJ, Yohannan J, Renner M, Akhtar A, Gregory A, Shulman M, Do DV, Nguyen QD. The role of biologic agents in the management of non-infectious uveitis. Expert Opin Biol Ther 2012; 12:995-1008. [PMID: 22780091 DOI: 10.1517/14712598.2012.688021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Uveitis is an intriguing group of disorders characterized by inflammation of the uveal tract. Due to the potential grave consequences of the disease process, it is important to assess the various therapeutic options available for treating uveitis, and their outcomes. AREAS COVERED This review discusses the use of conventional agents in the management of uveitis, including discussion of the molecular and clinical properties of corticosteroids, antimetabolites, calcineurin inhibitors and alkylating agents and their side effects. In addition, it also discusses the molecular and clinical properties of novel biologic agents and their side effects. Moreover, recommendations as to when biologic agents should be employed are also discussed. EXPERT OPINION We recommend that in general (except in selected cases of Adamantiades-Behçet's disease) biologics should not be used as a first-line therapy for uveitis due to inconvenience, high cost, and potential immunosuppressive effects. However, many biologics are potent in inducing drug-free remission of uveitis and may be employed to manage recurrent diseases or diseases not responsive to conventional agents.
Collapse
Affiliation(s)
- Jangwon Heo
- Johns Hopkins University School of Medicine, Wilmer Eye Institute, Johns Hopkins Hospital, Retinal Imaging Research and Reading Center, 600 North Wolfe Street, Maumenee 745, Baltimore, MD 21287, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
77
|
Complications infectieuses liées au traitement par anti-TNFα : à propos de deux cas de leishmaniose. J Fr Ophtalmol 2012; 35:695-9. [DOI: 10.1016/j.jfo.2012.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 06/10/2012] [Indexed: 11/19/2022]
|
78
|
Matsuda J, Kaburaki T, Kobayashi S, Numaga J. Treatment of recurrent anterior uveitis with infliximab in patient with ankylosing spondylitis. Jpn J Ophthalmol 2012; 57:104-7. [DOI: 10.1007/s10384-012-0202-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 08/28/2012] [Indexed: 10/27/2022]
|
79
|
Systemic treatment of vitreous inflammation. Mediators Inflamm 2012; 2012:936721. [PMID: 23028205 PMCID: PMC3457724 DOI: 10.1155/2012/936721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 08/21/2012] [Indexed: 02/07/2023] Open
Abstract
Non infectious vitreous inflammation is often vision threatening and can be associated with potentially life-threatening systemic conditions. Treatment is often challenging as it involves systemic medications that can be associated with adverse effects. The classes of drugs are ever expanding and include corticosteroids, antimetabolites, alkylating agents, T-cell and calcineurin agents, biologic agents, and interferons. Each class of systemic therapy for non-infectious vitreous inflammation is reviewed. We discuss the mechanisms of action, usual clinical dosages, the specific conditions that are treated, the adverse effects, and usual course of treatment for each class of therapy.
Collapse
|
80
|
Liu B, Sen HN, Nussenblatt R. Susceptibility Genes and Pharmacogenetics in Ocular Inflammatory Disorders. Ocul Immunol Inflamm 2012; 20:315-23. [DOI: 10.3109/09273948.2012.710706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
81
|
Morarji J, Joshi L, Tomkins-Netzer O, Lightman S, Taylor SRJ. Combined infliximab and rituximab in necrotising scleritis. Case Rep Ophthalmol 2012; 3:286-90. [PMID: 23275790 PMCID: PMC3530152 DOI: 10.1159/000342842] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We report a patient with necrotising scleritis in whom infliximab was used for short-term steroid-sparing while rituximab took effect. This enabled disease control without requiring an extended period of high-dose corticosteroid administration or the concurrent use of cyclophosphamide.
Collapse
Affiliation(s)
- Jiten Morarji
- Multidisciplinary Vasculitis Clinic, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK ; Royal Surrey County Hospital NHS Foundation Trust, Guildford, London, UK
| | | | | | | | | |
Collapse
|
82
|
Carron P, Van Praet L, Jacques P, Elewaut D, Van den Bosch F. Therapy for Spondyloarthritis. Rheum Dis Clin North Am 2012; 38:583-600. [DOI: 10.1016/j.rdc.2012.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
83
|
Abstract
The major comorbidities of ankylosing spondylitis include uveitis, bowel inflammation, psoriasis and heart disease. The pathogenic mechanism to account for the coexistence of comorbidities remains largely unknown. In some instances, the comorbidity has a major impact on the choice of therapy.
Collapse
|
84
|
Servat JJ, Mears KA, Black EH, Huang JJ. Biological agents for the treatment of uveitis. Expert Opin Biol Ther 2012; 12:311-28. [PMID: 22339439 DOI: 10.1517/14712598.2012.658366] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The conventional treatment of uveitis includes corticosteroids and immunosuppressive agents, which are highly efficacious, but can be associated with serious systemic side effects. Over the last two decades, advances in the understanding of the pathogenesis of inflammatory diseases, as well as improved biotechnology, have enabled selective targeting of the chemical mediators of diseases. Recently, a new class of drugs called biologics, that target the various mediators of the inflammation cascade, may potentially provide more effective and less toxic treatment. AREAS COVERED This article is a review and summary of the peer-reviewed evidence for biologic agents in the treatment of various forms of ocular inflammation and it focuses on the potential use of other biologic agents that have been tested in experimental autoimmune uveitis. Pubmed was used as our main tool for our literature search. Some additional references were taken from books written on the subject. EXPERT OPINION There are a wide variety of new and emerging biological agents currently being used in the treatment of uveitis which has expanded the therapeutic horizons far beyond previous limitations.
Collapse
Affiliation(s)
- Juan Javier Servat
- Yale University School of Medicine, Department of Ophthalmology and Visual Science, 40 Temple Street, NH 06510, USA
| | | | | | | |
Collapse
|
85
|
Stabilization of bilateral progressive rheumatoid corneal melt with infliximab. Case Rep Ophthalmol Med 2012; 2012:173793. [PMID: 22701193 PMCID: PMC3369392 DOI: 10.1155/2012/173793] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 04/04/2012] [Indexed: 12/31/2022] Open
Abstract
Purpose. To report the use of infliximab in the rapid stabilization of a case of progressive, bilateral rheumatoid peripheral ulcerative keratitis (PUK) that failed to respond to conventional immunosuppressive therapy.
Methods. A single interventional case report.
Results. A patient with rheumatoid arthritis presented with bilateral PUK following a 2-month history of ocular discomfort and redness. His systemic prednisolone (PDN) and methotrexate (MTX) were increased and, despite an initial favorable response, bilateral recurrent corneal perforations ensued. Both eyes underwent cyanoacrylate glue repair, amniotic membrane transplantation (AMT), and penetrating keratoplasty (PKP). Recurrence of the disease and bilateral perforations of the second PKP in both eyes prompted administration of intravenous infliximab immediately after the fourth PKP. The disease activity rapidly settled in both eyes, and at eighteen-month followup, after 12 infliximab infusions, the PUK remains quiescent with no further graft thinning or perforation. Conclusion. Infliximab can be used to arrest the progression of severe bilateral rheumatoid PUK in cases that are refractory to conventional treatment.
Collapse
|
86
|
Kim GT. Acute exacerbation of ankylosing spondylitis after chlamydial infection in a patient well-controlled with etanercept. Int J Rheum Dis 2012; 15:e113-5. [PMID: 23083043 DOI: 10.1111/j.1756-185x.2012.01748.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
87
|
|
88
|
Sukumaran S, Marzan K, Shaham B, Reiff A. High dose infliximab in the treatment of refractory uveitis: does dose matter? ISRN RHEUMATOLOGY 2012; 2012:765380. [PMID: 22389806 PMCID: PMC3263752 DOI: 10.5402/2012/765380] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 10/03/2011] [Indexed: 12/14/2022]
Abstract
Background. Infliximab (INF) has been shown to be beneficial in treating refractory uveitis, however, no data exist on optimal dosing and the efficacy of higher dosing. Objectives. To compare the efficacy of low-dose (LD) (<10 mg/kg), moderate-dose (MD) (≥10–15 mg/kg), and high-dose (HD) INF (≥15–20 mg/kg) in the treatment of uveitis. Methods. Retrospective chart review children with uveitis diagnosed at Childrens Hospital Los Angeles and Millers Children's Hospital, CA, USA. Results. Of the 34 INF-treated children, 6 patients received LD, 19 received MD, and 9 received HD. Average disease duration prior to therapy was 10.6, 24.6, and 37.1 months each group, respectively. Topical steroids were discontinued after an average of 3 months, 9.5 months, and 10.2 months in the LD, MD, and HD groups, respectively. We found that 66% of patients receiving LD, 42% of MD, and 66% receiving HD INF failed therapy and required either dose escalation or alternate medication for disease control. Conclusions. INF is beneficial in the treatment of uveitis, and dose escalation up to 4 times above the approved dose is often necessary to achieve disease control in patients with uveitis. Doses < 10 mg/kg every 4 weeks may not be sufficient to control disease.
Collapse
Affiliation(s)
- Sukesh Sukumaran
- Division of Pediatric Rheumatology, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA
| | | | | | | |
Collapse
|
89
|
|
90
|
|
91
|
GAUJOUX-VIALA CÉCILE, GIAMPIETRO CECILIA, GAUJOUX THOMAS, EA HANGKORNG, PRATI CLÉMENT, ORCEL PHILIPPE, WENDLING DANIEL, LIOTÉ FRÉDÉRIC. Scleritis: A Paradoxical Effect of Etanercept? Etanercept-associated Inflammatory Eye Disease. J Rheumatol 2011; 39:233-9. [DOI: 10.3899/jrheum.110865] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To describe 3 cases of scleritis associated with etanercept use for rheumatoid arthritis (RA) and to review the literature related to inflammatory eye diseases associated with the use of etanercept.Methods.Three cases of severe scleritis during etanercept therapy were analyzed. A systematic review of the literature in PubMed, Embase, and the Cochrane Library was performed, from 1962 to July 2010.Results.Three patients with seropositive RA developed scleritis 7–28 months after initiation of etanercept, for the first time during their long-lasting disease. In all patients the underlying disease had responded well to anti-tumor necrosis factor therapy. Ocular inflammation went into remission after discontinuation of etanercept, and no other relapses were observed. One patient experienced a dechallenge-rechallenge phenomenon (improvement in symptoms following discontinuation of the agent, then reappearance or worsening of symptoms on reexposure to the agent). Forty-two cases of inflammatory eye diseases believed to be associated with the use of etanercept have been reported in the literature: 33 uveitis, 8 scleritis, 1 orbital myositis, concerning 16 patients with RA, 10 with juvenile idiopathic arthritis, 14 with ankylosing spondylitis, and 2 with psoriatic spondyloarthropathy. Dechallenge was performed in 28 patients, leading to resolution of symptoms. Rechallenge was done in 6 cases, with clear exacerbation.Conclusion.Ocular inflammation is paradoxically a potential adverse effect of etanercept, even in previously uninvolved eyes.
Collapse
|
92
|
Kraus CL, Culican SM. Use of biologic agents in ocular manifestations of rheumatic disease. Int J Rheumatol 2011; 2012:203819. [PMID: 22229035 PMCID: PMC3246731 DOI: 10.1155/2012/203819] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 10/31/2011] [Indexed: 01/14/2023] Open
Abstract
Biologic agents have dramatically shifted the treatment paradigm for rheumatic disease. Use of these agents can decrease disease burden, allow the patient to be weaned from corticosteroids, and reduce the likelihood of relapse. Eye disease associated with rheumatic conditions may present with a wide range of signs and symptoms. This coexisting pathology should not be overlooked and should be considered a reason for initiation or continuation of biologic therapy. Additionally, many of the ocular manifestations of rheumatic disease respond preferentially to specific targeting molecules. This paper summarizes the available studies on the use, efficacy, and safety of biologic agents in the treatment of ocular manifestations of rheumatic disease.
Collapse
Affiliation(s)
- Courtney L. Kraus
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Susan M. Culican
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA
| |
Collapse
|
93
|
Wendling D, Paccou J, Berthelot JM, Flipo RM, Guillaume-Czitrom S, Prati C, Dernis E, Direz G, Ferrazzi V, Ristori JM. New Onset of Uveitis During Anti-Tumor Necrosis Factor Treatment for Rheumatic Diseases. Semin Arthritis Rheum 2011; 41:503-10. [DOI: 10.1016/j.semarthrit.2011.05.005] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 04/30/2011] [Accepted: 05/22/2011] [Indexed: 01/26/2023]
|
94
|
Erckens RJ, Mostard RLM, Wijnen PAHM, Schouten JS, Drent M. Adalimumab successful in sarcoidosis patients with refractory chronic non-infectious uveitis. Graefes Arch Clin Exp Ophthalmol 2011; 250:713-20. [PMID: 22119879 PMCID: PMC3332360 DOI: 10.1007/s00417-011-1844-0] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 09/26/2011] [Accepted: 10/03/2011] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Adalimumab, a humanized monoclonal antibody targeted against TNF-α, has proved to be successful in the treatment of uveitis. Another anti-TNF-α agent, i.e., infliximab, has been reported of benefit in the treatment of refractory sarcoidosis. The aim of this prospective case series was to evaluate the effect of adalimumab on intraocular inflammatory signs and other relevant clinical manifestations (lung function, serological inflammatory parameters, and fatigue) of sarcoidosis. METHODS Sarcoidosis patients with refractory posterior uveitis (n = 26, 17 females, 41 eyes in total) were systematically followed for 12 months after initiation of adalimumab 40 mg sc once a week. Inclusion criteria were non-responsiveness to prednisone and methotrexate (MTX) or intolerance to these drugs. Adjunctive therapy with prednisone and MTX was tapered during treatment with adalimumab. Localization and improvement, stabilization or deterioration of intraocular inflammatory signs was scored. Pulmonary function- and laboratory testing were performed and Fatigue Assessment Scale was completed. Results at baseline, 6 months, and 12 months were compared. RESULTS Choroidal involvement resolved in 10/15 patients, five had partial improvement; vasculitis resolved in 1/1 patient; papillitis resolved in 7/8 patients, one had partial response; macular edema resolved in 5/8 patients, three had partial response; vitreous cleared completely in 5/5 patients. Overall outcome regarding intraocular inflammatory signs showed improvement in 22 patients (85%) and stabilization in four patients (15%). At 12 months, no recurrences were reported in those successfully treated. Laboratory parameters of inflammatory activity (C-reactive protein; serum angiotensin-converting enzyme and soluble interleukin-2 Receptor) improved (p < 0.01). Moreover, fatigue improved in 14/21 (67%) of the patients suffering from fatigue and the diffusion capacity for carbon monoxide (DLCO) improved in 7/8 (88%) of patients with a decreased DLCO (p < 0.01). The dosage of both prednisone and MTX could be tapered down significantly (p < 0.01 and p < 0.05, respectively). CONCLUSIONS Adalimumab appeared successful in sarcoidosis patients with refractory chronic non-infectious uveitis showing improvement in intraocular inflammatory signs as well as in other relevant clinical indicators of disease activity. Future randomized studies are needed to determine the optimal dosage, dose interval and duration of therapy in refractory multisystemic sarcoidosis.
Collapse
Affiliation(s)
- R J Erckens
- Department of Ophthalmology, Maastricht University Medical Centre, P. Debyelaan 25, 6229, HX, Maastricht, The Netherlands.
| | | | | | | | | |
Collapse
|
95
|
Heiligenhaus A, Michels H, Schumacher C, Kopp I, Neudorf U, Niehues T, Baus H, Becker M, Bertram B, Dannecker G, Deuter C, Foeldvari I, Frosch M, Ganser G, Gaubitz M, Gerdes G, Horneff G, Illhardt A, Mackensen F, Minden K, Pleyer U, Schneider M, Wagner N, Zierhut M. Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis. Rheumatol Int 2011; 32:1121-33. [DOI: 10.1007/s00296-011-2126-1] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 08/22/2011] [Indexed: 12/14/2022]
|
96
|
Esterberg E, Acharya NR. Corticosteroid-sparing therapy: practice patterns among uveitis specialists. J Ophthalmic Inflamm Infect 2011; 2:21-8. [PMID: 22057810 PMCID: PMC3302992 DOI: 10.1007/s12348-011-0047-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Accepted: 10/20/2011] [Indexed: 12/19/2022] Open
Abstract
Purpose This study aims to determine uveitis specialists’ practice patterns, preferences, and perceptions of corticosteroid-sparing therapies for the initial treatment of chronic noninfectious uveitis. Methods A survey was distributed to the American Uveitis Society and Proctor email listservs in order to restrict the respondents to specialists who likely have extensive experience in the use of immunomodulatory therapy. Topics included effectiveness, usage, and preferences related to seven immunomodulatory treatments. Results Among the 45 responders, the majority (59%) had greater than 10 years of experience treating uveitis. Methotrexate was the most commonly used initial therapy for anterior, intermediate, and posterior/panuveitis (85%, 57%, and 37%), and the most preferred for anterior (55%). Mycophenolate mofetil was the most preferred for intermediate (35%) and posterior/panuveitis (42%). Primary reasons not to prescribe a treatment were effectiveness for azathioprine, safety/tolerability for cyclosporine and cyclophosphamide, and a mixture of cost, safety/tolerability, and difficulty of administration for the biologic drugs. Conclusions Within the group of highly experienced uveitis specialists, methotrexate is still the most commonly used initial treatment. Although newer biologic drugs are seen as effective, they are not commonly used, or even preferred, as initial corticosteroid-sparing treatment.
Collapse
Affiliation(s)
- Elizabeth Esterberg
- F.I. Proctor Foundation, University of California San Francisco, Room S309, 513 Parnassus Avenue, San Francisco, CA, 94143-0412, USA
| | | |
Collapse
|
97
|
Durrani K, Zakka FR, Ahmed M, Memon M, Siddique SS, Foster CS. Systemic Therapy With Conventional and Novel Immunomodulatory Agents for Ocular Inflammatory Disease. Surv Ophthalmol 2011; 56:474-510. [DOI: 10.1016/j.survophthal.2011.05.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 05/18/2011] [Accepted: 05/24/2011] [Indexed: 12/19/2022]
|
98
|
Siddique SS, Shah R, Suelves AM, Foster CS. Road to remission: a comprehensive review of therapy in uveitis. Expert Opin Investig Drugs 2011; 20:1497-515. [PMID: 21936708 DOI: 10.1517/13543784.2011.617741] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Although uveitis remains the third leading cause of preventable blindness in the US, the care and management of patients with uveitis and ocular inflammatory disease sit poised to make evolutionary if not revolutionary changes in the years ahead. This review serves to highlight important advances in the pharmacologic options available for the treatment of uveitis and ocular inflammation. AREAS COVERED Advances in steroid therapy (both topical and extended delivery), updates in the clinical safety of systemic immune modulation, and the emerging therapies for uveitis and ocular inflammatory disease are some of the areas covered in this review. EXPERT OPINION Corticosteroids have been the mainstay in the care of patients with ocular inflammatory disorders for many years. Indeed, some physicians still use only steroids for treating inflamed eyes. However, the mission is remission of all corticosteroids in order to prevent the complications associated with long-term corticosteroid use. The goal is to achieve quiescence through aggressive use of corticosteroids to extinguish the fire and then move along to achieve steroid-free remission through immunosuppressant agents.
Collapse
Affiliation(s)
- Sana S Siddique
- Massachusetts Eye Research and Surgery Institution, 5 Cambridge Center, 8th floor, Cambridge, MA 02412 , USA.
| | | | | | | |
Collapse
|
99
|
Pham M, Chow CC, Badawi D, Tu EY. Use of infliximab in the treatment of peripheral ulcerative keratitis in Crohn disease. Am J Ophthalmol 2011; 152:183-188.e2. [PMID: 21652024 DOI: 10.1016/j.ajo.2011.01.059] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 01/28/2011] [Accepted: 01/29/2011] [Indexed: 12/11/2022]
Abstract
PURPOSE To report the effectiveness of infliximab in the treatment of peripheral ulcerative keratitis (PUK) associated with Crohn disease. DESIGN Retrospective, interventional case series. METHODS SETTING Institutional, academic referral setting. patient or study population: Six eyes of 3 patients with PUK associated with Crohn disease that failed or were intolerant to traditional immunosuppression such as oral prednisone and cyclophosphamide. INTERVENTION OR OBSERVATION PROCEDURE(S): Infliximab intravenous infusion 5 mg/kg every 2 to 8 weeks. MAIN OUTCOME MEASURE(S) Subjective outcome such as pain improvement and objective outcomes such as visual acuity, signs of inflammation, and progression of corneal thinning. RESULTS Symptom of pain improved in all patients. Visual acuity remained stable in 4 of 6 eyes, improved in 1 of 6 eyes, and worsened in 1 of 6 eyes (secondary to stromal scar). Rapid resolution of inflammation and arrest of further thinning were observed in all 6 eyes. Similar effects were observed on recurrence treated with repeat dosing of infliximab in 5 of 6 eyes. CONCLUSIONS Infliximab produced a rapid, dramatic, repeatable suppression of corneal inflammation, pain, and keratolysis in PUK associated with Crohn disease. Although the effect of long-term therapy with these agents is unknown, infliximab should be considered in patients with Crohn-associated PUK not amenable to traditional therapy. Larger prospective studies are needed to determine the efficacy of infliximab in this aggressive disease entity.
Collapse
|
100
|
Penha FM, Rodrigues EB, Furlani BA, Dib E, Melo GB, Farah ME. Toxicological considerations for intravitreal drugs. Expert Opin Drug Metab Toxicol 2011; 7:1021-34. [DOI: 10.1517/17425255.2011.585970] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|