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De Simone L, Gentile P, Aldigeri R, Mastrofilippo V, Bolletta E, Gozzi F, Adani C, Salvarani C, Cimino L. Effectiveness of Pegylated Interferon Alpha-2a in Post-Uveitic Macular Edema Previously Responding to Non-Pegylated Interferon. Ocul Immunol Inflamm 2024; 32:678-682. [PMID: 37093910 DOI: 10.1080/09273948.2023.2195494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/21/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE To evaluate the efficacy of pegylated interferon (PEG-IFN) alpha-2a to treat post-uveitic relapsing macular edema (ME) after withdrawal of non-PEG IFN alpha-2a or 2b to maintain treatment efficacy. METHODS This retrospective study investigated subjects with post-uveitic ME who received weekly subcutaneous PEG-IFN alpha-2a injections. Comparisons between baseline central macular thickness (CMT) and best-corrected visual acuity (BCVA) and those at all follow-up visits were made. RESULTS Six patients (nine eyes) were treated and followed up for six months. CMT (mean [standard deviation]) decreased from 375[117] to 283[39] μm after one month (p < 0.001), remaining significantly lower up to the final follow-up visit at six months (275[38] μm, p = 0.008), and BCVA (0.21[0.16] logMAR at baseline) showed an improvement of 0.12[0.11] logMAR (p = 0.026) at six months. Neither recurrences nor any serious adverse events were recorded. CONCLUSIONS Post-uveitic ME patients were effectively and safely treated with PEG-IFN alpha-2a.
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Affiliation(s)
- L De Simone
- Ocular Immunology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - P Gentile
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - R Aldigeri
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - V Mastrofilippo
- Ocular Immunology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - E Bolletta
- Ocular Immunology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - F Gozzi
- Ocular Immunology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - C Adani
- Ocular Immunology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - C Salvarani
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
- Division of Rheumatology, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - L Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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2
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Del-Piñal M, Klein-Burgos C, Martín-Ucero AM, Larrañaga-Cores M, de la Hoz A, López-Vázquez A, Fernández-Gutiérrez E. Acute Fibrinous Anterior Uveitis in a Patient Treated With Topical Interferon-α2b for Ocular Surface Squamous Neoplasia With Uveitis Susceptibility. Cornea 2023; 42:648-650. [PMID: 36747320 DOI: 10.1097/ico.0000000000003254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/11/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE To report a case of fibrinous acute anterior uveitis associated with topical interferon-α2b (IFN-α2b) treatment for ocular surface squamous neoplasia in a patient with HLA-B27 uveitis predisposition. METHODS Case report. RESULTS We present the case of a 57-year-old man who received topical IFN-α2b as adjuvant therapy for a previously surgically removed ocular surface squamous neoplasia with affected surgical margins. Two weeks after topical IFN-α2b initiation, the patient was diagnosed with fibrinous acute anterior uveitis. Complementary tests to rule out other causes of uveitis resulted to be negative, except for HLA-B27, which tested positive. Response to treatment with topical corticosteroids and cyclopentolate was favorable. As IFN-α2b is considered an immune enhancer and has been widely associated with autoimmune side effects, topical therapy with IFN-α2b was temporally ceased until intraocular inflammation resolved. Topical IFN-α2b was resumed, and during follow-up, no signs of uveitis were detected. The main hypothesis is that IFN-α2b acts as a trigger for intraocular inflammation in individuals with uveitis predisposition. CONCLUSIONS Topical IFN-α2b could trigger intraocular inflammation in patients with uveitis susceptibility. It may be reasonable to use IFN-α2b cautiously in patients with a known history of uveitis or uveitis predisposition.
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Affiliation(s)
- Miguel Del-Piñal
- Department of Ophthalmology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Ana M Martín-Ucero
- Department of Ophthalmology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Adriana de la Hoz
- Department of Ophthalmology, Hospital Universitario de Torrejón, Madrid, Spain; and
- Department of Retina, Clínica Miranza, Madrid, Spain
| | - Ana López-Vázquez
- Department of Ophthalmology, Hospital Universitario La Paz, Madrid, Spain
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3
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Kawali A, Sanjay S, Mohan A, Mahendradas P, Shetty R. Topical interferon therapy in uveitic macular edema. Indian J Ophthalmol 2022; 70:4357-4361. [PMID: 36453344 PMCID: PMC9940588 DOI: 10.4103/ijo.ijo_1450_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To evaluate efficacy of topical interferon alfa-2b (IFN) in the treatment of uveitic macular edema (UME). Methods This is a prospective, interventional case study of patients with UME. Injection IFN was reconstituted into eye drops and a four times/day (QID) application was prescribed. Central macular thickness (CMT) on optical coherence tomography (OCT) scan was evaluated. Improvement in CMT by ≥50 μm from the baseline was studied in eyes with presenting CMT ≥400 μm. Results Twenty eyes of 20 patients with UME were studied: anterior uveitis (n = 3), anterior + intermediate uveitis (n = 5), posterior uveitis (n = 3), retinal vasculitis (n = 3), and panuveitis (n = 6). Mean CMT at the presentation was 423.3 μm (range: 270-604 μm), which improved at 1 month (n = 16), 2 months (n = 10), and ≥3 months (n = 11) follow-up, to 415.3 μm (range: 247-579 μm) (P = 0.411), 364.4 μm (range: 258-566 μm) (P = 0.099), 344 μm (range: 258-484 μm) (P = 0.001), respectively. Twelve eyes of 12 patients had presenting CMT ≥400 μm. In these cases, decrease in CMT by ≥50 μm was seen in 4/10, 4/5, and 5/6 eyes at 1 and 2 months and ≥3 months follow-up. Mean follow-up was 4 months (range: 1-17 months). Complete resolution of UME was seen only in three eyes. No ocular or systemic side effects were observed. Conclusion Topical IFN therapy in QID doses is safe but may have limited role in UME. Long-term therapy may improve its efficacy. Larger studies with dose modification, combination with other drugs, and with homogeneous uveitis population are recommended.
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Affiliation(s)
- Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India,Correspondence to: Dr. Ankush Kawali, Narayana Nethralaya, Chord Road, Rajajinagar, Bengaluru, Karnataka, India. E-mail:
| | - Srinivasan Sanjay
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Ashwin Mohan
- Department of Vireo-Retina, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Padmamalini Mahendradas
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Phaco-Refractive, Narayana Nethralaya, Bengaluru, Karnataka, India
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Hage DG, Wahab CH, Kheir WJ. Choroidal sarcoid granuloma: a case report and review of the literature. J Ophthalmic Inflamm Infect 2022; 12:31. [PMID: 36173484 PMCID: PMC9521566 DOI: 10.1186/s12348-022-00309-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Choroidal sarcoid granulomas are often diagnosed in patients without a prior history of sarcoidosis. They are often mistaken for choroidal metastasis, choroidal nevi, amelanotic choroidal melanomas, and uveal lymphomas; however, are easily treatable when accurately identified. OBSERVATIONS We searched PubMed, Medline, and Scopus for English-Language case reports published before September 2021. Additionally, we presented a case of a 45-year-old woman with a right-sided amelanotic choroidal mass whose diagnosis was delayed by a COVID-19 infection. Of the 26 cases reported in the literature, 46% were female, 38% were African American, and 19% had bilateral involvement. There was a mean age of 42.15 years and a mean follow-up period of 27 months. The most common complaint was of a progressive, painless blurring of vision, and only five patients had been previously diagnosed with sarcoidosis. The choroidal granulomas were typically described as yellow lesions, single or multiple, found temporal to or at the macula. Most patients were administered steroids, with 69% receiving them systemically, 5% topically, and 8% locally with a triamcinolone injection. All patients reported symptomatic improvement at their final follow-up with resolution of the mass in 65% of patients and improved visual acuity in 76%. CONCLUSION Primary testing including fundoscopy, fluorescein angiography, fundus autofluorescence, A/B-scan, and OCT are useful for diagnosis, differentiation from other choroidal lesions, and monitoring treatment response. Steroids are a mainstay of treatment for sarcoidosis and are effective at treating choroidal granulomas. Therefore, early recognition and diagnosis of choroidal granulomas is imperative as treatment can be curative and sight-sparing.
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Affiliation(s)
- Dany G Hage
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Charbel H Wahab
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wajiha J Kheir
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon.
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5
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Kawali A, Sanjay S, Mohan A, Mahendradas P, Shroff S, Shetty R. Intensive topical interferon therapy in uveitic macular edema. Indian J Ophthalmol 2022; 70:2986-2989. [PMID: 35918958 DOI: 10.4103/ijo.ijo_3210_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To evaluate the efficacy of intensive topical interferon alfa-2b (IFN) therapy in uveitic macular edema (UME). Methods This is a prospective, interventional case study of eyes with UME. Commercially available injection IFN for subcutaneous use was reconstituted to form eye drops and a dose of 6 times/day for 2 weeks, 5 times/day for next 2 weeks, followed by 4, 3, 2, 1 taper per month was prescribed. Optical coherence tomography (OCT) and clinical examination was done at 0, 2, 4, 8 weeks, and further as required. Results Nine eyes of 9 patients with UME were studied. Mean central macular thickness (CMT) at presentation was 522.2 μm (range: 408-803 μm). At 2-week, 1-month, and 2-month follow-up, mean CMT decreased to 451.6 μm (range: 322-524 μm), 375.8 μm (range: 287-480 μm), and 360.3 μm (range: 260-485 μm), respectively. Four eyes which showed inadequate response to previous topical IFN therapy (4 times/day) showed significant improvement with intensive therapy at 1 month follow-up. In 4 eyes, UME resolved completely with mean CMT 285.5 μm (range: 260-312 μm) at 7.5 weeks (range: 4-12 weeks). Study exit was seen in 2 cases due to inadequate response and relapse of uveitis. Mean follow up was 3.38 months (range: 1-5 months). Conclusion Intensive topical IFN therapy can be an alternative therapeutic option in the treatment of UME. Study of intraocular penetration, combination with other drugs, and the efficacy of IFN separately for different uveitic entities may explore new avenues in treatment of UME.
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Affiliation(s)
- Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Srinivasan Sanjay
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Ashwin Mohan
- Department of Retina, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Padmamalini Mahendradas
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Sujani Shroff
- Department of Glaucoma, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive, Narayana Nethralaya, Bangalore, Karnataka, India
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Kato A, Ishihara M, Mizuki N. Interferon-induced sarcoidosis with uveitis as the initial symptom: a case report and review of the literature. J Med Case Rep 2021; 15:568. [PMID: 34836557 PMCID: PMC8626977 DOI: 10.1186/s13256-021-03181-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 11/03/2021] [Indexed: 12/24/2022] Open
Abstract
Background In recent years, numerous studies have reported the development or exacerbation of sarcoidosis due to interferon therapy. However, ocular lesions rarely present as initial symptoms. Herein, we describe a rare case of interferon-α-induced sarcoidosis with uveitis as the initial symptom, and present a review of the relevant literature. Case presentation This case involved a 62-year-old-Japanese woman with a history of a combination treatment of pegylated interferon-α-2a, ribavirin, and simeprevir, after which she developed granulomatous panuveitis. She was subsequently diagnosed with sarcoidosis following histological examination of skin biopsy specimens. In addition to reporting this case, we performed a literature review of 27 cases (24 case reports) of histopathologically diagnosed interferon-α-induced sarcoidosis published between January 2009 and November 2018. Conclusions Among the reviewed cases, 23 (85.1%) cases developed skin lesions and 19 (70.1%) had lung lesions. Only three cases (11.1%) had accompanying eye lesions. Interferon-α therapy was discontinued in 16 cases (52.9%), and the majority exhibited improvement after systemic corticosteroid treatment. There are few reported cases of interferon-α-induced sarcoidosis with uveitis as the initial symptom. However, if uveitis develops during or after interferon-α treatment, it might represent an initial symptom of interferon-α-induced sarcoidosis, as observed in the present case.
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Affiliation(s)
- Ai Kato
- Department of Ophthalmology and Visual Science, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Mami Ishihara
- Department of Ophthalmology and Visual Science, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
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Armstrong JJ, Zhang R, Fung M, Zeman-Pocrnich C, Rotenberg B, Bauman G, Gilbert K, Hutnik CM. Rapid visual field progression in a patient with glaucoma as the presenting manifestation of sarcoidosis. Am J Ophthalmol Case Rep 2021; 23:101132. [PMID: 34151046 PMCID: PMC8192818 DOI: 10.1016/j.ajoc.2021.101132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To report a case of accelerated visual field progression secondary to a new orbital apex lesion in a patient with a longstanding history of fatigue and cough. OBSERVATIONS A 73-year-old myopic female with known open angle glaucoma presented with accelerated unilateral visual field progression. Maximally tolerated medical therapy was instituted over a period of 1-2 years with imminent discussions of surgical intervention. Around this time the patient reported worsening cough and fatigue, which were initially attributed to glaucoma medication side effects. Consideration of the patient's remote history of melanoma and the current asymmetry of the visual field progression triggered a computerized tomography (CT) scan of the orbits as part of the management. An orbital apex lesion was discovered, raising suspicion for metastatic melanoma, and restaging CT imaging uncovered renal, hepatic, and mediastinal masses. Unexpectedly, biopsies revealed non-necrotizing granulomatous inflammatory processes consistent with a diagnosis of sarcoidosis. It is perhaps noteworthy that the patient had received interferon therapy for management of her melanoma; previous reports have associated interferon exposure with subsequent sarcoid disease, regardless of duration of therapy or elapsed time since exposure. CONCLUSIONS AND IMPORTANCE Although rare, sarcoidosis can occur virtually anywhere in the body, including the orbital apex. Its common early symptoms, fatigue and cough, are insidious and seen frequently in this patient's age group and medication side effect profile. It is important to maintain an appropriate index of suspicion when monitoring atypical visual field progression in a patient with glaucoma. In this case, imaging, subsequent biopsy, and a multi-specialty team were integral to this patient's diagnosis and management.
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Affiliation(s)
- James J. Armstrong
- Department of Ophthalmology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Richard Zhang
- Department of Ophthalmology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Matthew Fung
- Department of Ophthalmology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Cady Zeman-Pocrnich
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Brian Rotenberg
- Department of Otolaryngology – Head & Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Glenn Bauman
- Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kenneth Gilbert
- Division of General Internal Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Cindy M.L. Hutnik
- Department of Ophthalmology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Ivey Eye Institute, St. Joseph's Hospital, London, Ontario, Canada
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8
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Sobolewska B, Baglivo E, Edwards AO, Kramer M, Miserocchi E, Palestine AG, Schwab IR, Zamir E, Doycheva D, Zierhut M. Drug-induced Sarcoid Uveitis with Biologics. Ocul Immunol Inflamm 2021; 30:907-914. [PMID: 33596386 DOI: 10.1080/09273948.2020.1850799] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose/Objectives: to evaluate new onset uveitis or reactivated uveitis by biologic agents and characterize their features.Materials and Methods: This is a multicenter, retrospective case series. Patients under biologic therapy were included if they developed uveitis for the first time or experienced intraocular inflammation which was different in location or laterality to previous inflammation.Results: Sixteen patients were identified. The underlying disorders included ankylosing spondylitis, juvenile idiopathic arthritis, rheumatoid arthritis, and Behçet's Disease. The biologic agents associated with a first episode of uveitis (n = 11) or with a new recurrence of uveitis (n = 5) were etanercept, adalimumab, abatacept, infliximab, and golimumab. Sarcoidosis based on bihilar lymphadenopathy, other computer tomography-findings, or biopsy was diagnosed in five patients under therapy with etanercep, adalimumab, and abatacept. Additionally, seven patients developed clinical changes in their uveitis pattern, suggesting sarcoid uveitis.Conclusions: Biologic treatment-induced uveitis often presents as granulomatous disease.
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Affiliation(s)
- Bianka Sobolewska
- Center of Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | | | - Albert O Edwards
- Oregon Retina Division of Sterling Vision, Eugene, OR, and Casey Eye Institute, Oregon Health Sciences University, Portland, Oregon, USA
| | - Michal Kramer
- Rabin Medical Center, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Alan G Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ivan R Schwab
- Department of Ophthalmology & Visual Science, University of California, Davis, Sacramento, California, USA
| | - Ehud Zamir
- Centre for Eye Research Australia, Melbourne, Australia
| | - Deshka Doycheva
- Center of Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Manfred Zierhut
- Center of Ophthalmology, University of Tuebingen, Tuebingen, Germany
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Narula N, Iannuzzi M. Sarcoidosis: Pitfalls and Challenging Mimickers. Front Med (Lausanne) 2021; 7:594275. [PMID: 33505980 PMCID: PMC7829200 DOI: 10.3389/fmed.2020.594275] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022] Open
Abstract
Sarcoidosis, a systemic granulomatous disease of unknown etiology, may mimic other conditions at presentation often resulting in delayed diagnosis. These conditions include infections, neoplasms, autoimmune, cardiovascular, and drug-induced diseases. This review highlights the most common sarcoidosis mimics that often lead to pitfalls in diagnosis and delay in appropriate treatment. Prior to invasive testing and initiating immunosuppressants (commonly corticosteroids), it is important to exclude sarcoid mimickers.
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Affiliation(s)
- Naureen Narula
- Staten Island University Hospital, New York, NY, United States
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10
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Hassan M, Karkhur S, Bae JH, Halim MS, Ormaechea MS, Onghanseng N, Nguyen NV, Afridi R, Sepah YJ, Do DV, Nguyen QD. New therapies in development for the management of non-infectious uveitis: A review. Clin Exp Ophthalmol 2020; 47:396-417. [PMID: 30938012 DOI: 10.1111/ceo.13511] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/16/2019] [Accepted: 03/24/2019] [Indexed: 02/06/2023]
Abstract
Uveitis is a spectrum of inflammatory disorders characterized by ocular inflammation and is one of the leading causes of preventable visual loss. The main aim of the treatment of uveitis is to control the inflammation, prevent recurrences of the disease and preserve vision while minimizing the adverse effects associated with the therapeutic agents. Initial management of uveitis relies heavily on the use of corticosteroids. However, monotherapy with high-dose corticosteroids is associated with side effects and cannot be maintained long term. Therefore, steroid-sparing agents are needed to decrease the burden of steroid therapy. Currently, the therapeutic approach for non-infectious uveitis (NIU) consists of a step-ladder strategy with the first-line option being corticosteroids in various formulations followed by the use of first-, second- and third-line agents in cases with suboptimal steroid response. Unfortunately, the agents currently at our disposal have limitations such as having a narrow therapeutic window along with their own individual potential side-effect profiles. Therefore, research has been targeted to identify newer drugs as well as new uses for older drugs that target specific pathways in the inflammatory response. Such efforts are made in order to provide targeted and safer therapy with reduced side effects and greater efficacy. Several specially designed molecular antibodies are currently in various phases of investigations that can potentially halt the inflammation in patients with NIU. In the review, we have provided a comprehensive overview of the current and upcoming therapeutic options for patients with NIU.
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Affiliation(s)
- Muhammad Hassan
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Samendra Karkhur
- Byers Eye Institute, Stanford University, Palo Alto, California.,Department of Ophthalmology, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Jeong H Bae
- Byers Eye Institute, Stanford University, Palo Alto, California.,Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Maria S Ormaechea
- Byers Eye Institute, Stanford University, Palo Alto, California.,Department of Ophthalmology, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Neil Onghanseng
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Nam V Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Rubbia Afridi
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Yasir J Sepah
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Diana V Do
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Quan D Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California
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11
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Radosavljevic A, Agarwal M, Bodaghi B, Smith JR, Zierhut M. Medical Therapy of Uveitic Macular Edema: Biologic Agents. Ocul Immunol Inflamm 2020; 28:1239-1250. [PMID: 32058830 DOI: 10.1080/09273948.2019.1709648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Introduction: Uveitic macular edema (UME) is a significant cause of visual impairment in all uveitis types. Methods: Reports that were cited in the MEDLINE database, that analyzed the effectiveness of biologics for UME in at least five patients, with a minimum follow-up of 3 months, published prior to April 1, 2019 were included. Reports that did not compare UME findings before and after the therapy, using either OCT or fluorescein angiography, were excluded. Results: Case series that analyzed the efficacy of intravitreal anti-VEGF agents showed modest, short-term benefit. Studies that investigated systemic anti-TNF agents in patients with noninfectious uveitis reported a therapeutic effect on UME. Anti-IL-6 antibodies have shown promising results for most severe cases of noninfectious UME. Interferon represents an option for patients with persistent UME in infectious and noninfectious uveitis. Conclusion: Multicenter, randomized controlled trials are needed to assess the effectiveness of each group of biologic agents in sufficient number of patients.
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Affiliation(s)
| | - Mamta Agarwal
- Uveitis & Cornea Services, Sankara Nethralaya , Chennai, India
| | - Bahram Bodaghi
- Department of Ophthalmology, IHU FORESIGHT, Pitié-Salpêtrière Hospital, APHP, Sorbonne-University , Paris, France
| | - Justine R Smith
- College of Medicine and Public Health, Flinders University , Adelaide, Australia
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tuebingen , Tuebingen, Germany
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12
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De Simone L, Sangiovanni A, Aldigeri R, Mastrofilippo V, Bolletta E, Invernizzi A, Fares L, Pipitone N, Fontana L, Salvarani C, Cimino L. Interferon Alpha-2a Treatment for Post-Uveitic Refractory Macular Edema. Ocul Immunol Inflamm 2019; 28:322-328. [DOI: 10.1080/09273948.2019.1589526] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- L. De Simone
- Ocular Immunology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
- Ophthalmology, Rome, Italy
| | - A. Sangiovanni
- Ocular Immunology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - R. Aldigeri
- Medicine and Surgery Department, University of Parma, Parma, Italy
| | - V. Mastrofilippo
- Ocular Immunology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
- Ophthalmology Department, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - E. Bolletta
- Ocular Immunology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - A. Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, Luigi Sacco Hospital, University of Milan, Milan, Italy
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - L. Fares
- Pharmacy Department, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - N. Pipitone
- Division of Rheumatology, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - L. Fontana
- Ophthalmology Department, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - C. Salvarani
- Division of Rheumatology, Azienda USL-IRCCS, Reggio Emilia, Italy
- Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - L. Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
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Biologics for the treatment of noninfectious uveitis: current concepts and emerging therapeutics. Curr Opin Ophthalmol 2019; 30:138-150. [PMID: 30844945 DOI: 10.1097/icu.0000000000000562] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW There is mounting evidence supporting the use of biologic therapeutics for the management of noninfectious uveitis (NIU). This review highlights: biologics with documented efficacy in NIU; agents with ongoing evaluation for efficacy in uveitis; and therapeutics for which investigation for efficacy in NIU is warranted. RECENT FINDINGS The tumor necrosis factor-alpha (TNF-α) inhibitor adalimumab has recently gained approval by the Food and Drug Administration for the treatment of noninfectious intermediate, posterior, and panuveitis. There is mounting evidence supporting the use of tocilizumab and rituximab in NIU. There is developing interest in evaluating the interleukin (IL)-23 inhibitors for efficacy in NIU. SUMMARY The TNF-α inhibitors adalimumab and infliximab have the greatest body of data supporting their use in NIU. These agents are considered second-line therapy for most forms of NIU but may be considered first-line therapy for uveitis associated with Behçet's disease and juvenile idiopathic arthritis. The B-cell inhibitor rituximab and the IL-6 inhibitor tocilizumab also have documented efficacy in NIU. Tocilizumab and interferon therapy may be particularly efficacious in the management of uveitic macular edema. The IL-23 inhibitors and janus kinase inhibitors are agents whose efficacy in NIU will likely be determined in the near future.
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Chopra A, Nautiyal A, Kalkanis A, Judson MA. Drug-Induced Sarcoidosis-Like Reactions. Chest 2018; 154:664-677. [PMID: 29698718 DOI: 10.1016/j.chest.2018.03.056] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 01/02/2023] Open
Abstract
A drug-induced sarcoidosis-like reaction (DISR) is a systemic granulomatous reaction that is indistinguishable from sarcoidosis and occurs in a temporal relationship with initiation of an offending drug. DISRs typically improve or resolve after withdrawal of the offending drug. Four common categories of drugs that have been associated with the development of a DISR are immune checkpoint inhibitors, highly active antiretroviral therapy, interferons, and tumor necrosis factor-α antagonists. Similar to sarcoidosis, DISRs do not necessarily require treatment because they may cause no significant symptoms, quality of life impairment, or organ dysfunction. When treatment of a DISR is required, standard antisarcoidosis regimens seem to be effective. Because a DISR tends to improve or resolve when the offending drug is discontinued, this is another effective treatment for a DISR. However, the offending drug need not be discontinued if it is useful, and antigranulomatous therapy can be added. In some situations, the development of a DISR may suggest a beneficial effect of the inducing drug. Understanding the mechanisms leading to DISRs may yield important insights into the immunopathogenesis of sarcoidosis.
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Affiliation(s)
- Amit Chopra
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY.
| | - Amit Nautiyal
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY
| | - Alexander Kalkanis
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, 401 Military and VA Hospital, Athens, Greece
| | - Marc A Judson
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY
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Fardeau C, Simon A, Rodde B, Viscogliosi F, Labalette P, Looten V, Tézenas du Montcel S, LeHoang P. Interferon-alpha2a and Systemic Corticosteroid in Monotherapy in Chronic Uveitis: Results of the Randomized Controlled BIRDFERON Study. Am J Ophthalmol 2017; 177:182-194. [PMID: 28315319 DOI: 10.1016/j.ajo.2017.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 03/04/2017] [Accepted: 03/06/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Macular edema is the leading cause of vision loss in bilateral chronic noninfectious posterior uveitis, and is currently being treated using corticosteroids, immunosuppressive agents, and biotherapies. The aim of this trial was to assess and compare the efficacy and safety of corticosteroids and interferon-α (IFN-α) in adults with such conditions. DESIGN Randomized controlled trial. METHODS Subjects: Adult patients with bilateral posterior autoimmune noninfectious and nontumoral uveitis complicated by macular edema in at least 1 eye. INTERVENTION Patients received either subcutaneous IFN-α2a, systemic corticosteroids, or no treatment for 4 months. The efficacy and safety were assessed for up to 4 months. MAIN OUTCOME MEASURES The main endpoint was the change of the central foveal thickness (CFT) obtained by optical coherence tomography. RESULTS Forty-eight patients were included. In intention-to-treat analysis, the median CFT change showed no significant difference. However, the per-protocol analysis showed a significant difference between groups for both eyes (OD and OS), and for the worse and better eyes. Statistically significant difference was found between the control and corticosteroid groups for the OD (P = .0285), and between the control and IFN-α groups for the OD (P = .0424) and worse eye (P = .0354). Serious adverse events occurred in 2 patients in the IFN group, in 1 patient in the corticosteroid group, and in 2 patients in the control group and were completely resolved after switch. CONCLUSIONS IFN-α and systemic corticosteroids, compared with no treatment, were associated with significant anatomic and visual improvement shown in the per-protocol study.
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You C, Sahawneh HF, Ma L, Kubaisi B, Schmidt A, Foster CS. A review and update on orphan drugs for the treatment of noninfectious uveitis. Clin Ophthalmol 2017; 11:257-265. [PMID: 28203051 PMCID: PMC5298311 DOI: 10.2147/opth.s121734] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction Uveitis, a leading cause of preventable blindness around the world, is a critically underserved disease in regard to the medications approved for use. Multiple immunomodulatory therapy (IMT) drugs are appropriate for uveitis therapy but are still off-label. These IMT agents, including antimetabolites, calcineurin inhibitors, alkylating agents, and biologic agents, have been designated as “orphan drugs” and are widely used for systemic autoimmune diseases or organ transplantation. Area covered The purpose of this paper is to comprehensively review and summarize the approved orphan drugs and biologics that are being used to treat systemic diseases and to discuss drugs that have not yet received approval as an “orphan drug for treating uveitis” by the US Food and Drug Administration (FDA). Our perspective IMT, as a steroid-sparing agent for uveitis patients, has shown promising clinical results. Refractory and recurrent uveitis requires combination IMT agents. IMT is continued for a period of 2 years while the patient is in remission before considering tapering medication. Our current goals include developing further assessments regarding the efficacy, optimal dose, and safety in efforts to achieve FDA approval for “on-label” use of current IMT agents and biologics more quickly and to facilitate insurance coverage and expand access to the products for this orphan disease.
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Affiliation(s)
- Caiyun You
- Massachusetts Eye Research and Surgery Institution (MERSI), Waltham; Ocular Immunology and Uveitis Foundation, Weston, MA, USA; Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Haitham F Sahawneh
- Massachusetts Eye Research and Surgery Institution (MERSI), Waltham; Ocular Immunology and Uveitis Foundation, Weston, MA, USA
| | - Lina Ma
- Massachusetts Eye Research and Surgery Institution (MERSI), Waltham; Ocular Immunology and Uveitis Foundation, Weston, MA, USA
| | - Buraa Kubaisi
- Massachusetts Eye Research and Surgery Institution (MERSI), Waltham; Ocular Immunology and Uveitis Foundation, Weston, MA, USA
| | - Alexander Schmidt
- Massachusetts Eye Research and Surgery Institution (MERSI), Waltham; Ocular Immunology and Uveitis Foundation, Weston, MA, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution (MERSI), Waltham; Ocular Immunology and Uveitis Foundation, Weston, MA, USA; Harvard Medical School, Boston, MA, USA
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Fardeau C, Champion E, Massamba N, LeHoang P. Uveitic macular edema. Eye (Lond) 2016; 30:1277-1292. [PMID: 27256304 DOI: 10.1038/eye.2016.115] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 04/23/2016] [Indexed: 02/06/2023] Open
Abstract
Macular edema (ME) may complicate anterior, intermediate, and posterior uveitis, which may be because of various infectious, neoplastic or autoimmune etiologies. BRB breakdown is involved in the pathogenesis of Uveitic ME (UME). Optical coherence tomography has become a standard tool to confirm the diagnosis of macular thickening, due to its non-invasive, reproducible, and sensitive features. Retinal fluorescein and indocyanine green angiography is helpful to study the macula and screen for associated vasculitis, detect ischemic areas and preretinal, prepapillary or choroidal neovascular complications, and it may provide information about the etiology and be needed to assess the therapeutic response. UME due to an infection or neoplastic infiltration may require a specific treatment. If it remains persistent or occurs in other etiologies, immunomodulatory treatments may be needed. Intravitreal, subconjunctival, or subtenon corticosteroids are widely used. Their local use is contraindicated in glaucoma patients and limited by their short-lasting action. In case of bilateral sight-threatening chronic posterior uveitis, systemic treatments are usually needed, and corticosteroids are used as the standard first-line therapy. In order to reduce the daily steroid dose, immunosuppressive or immunomodulatory agents may be added, some of them being now available intravitreally. Ongoing prospective studies are assessing biotherapies and immunomodulators to determine their safety and efficacy in this indication.
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Affiliation(s)
- C Fardeau
- Department of Ophthalmology, Reference Centre for Rare Diseases, Hôpital Pitié-Salpêtrière, University Hospital Department of Vision and Disability, Pierre and Marie Curie University, Paris VI, 47-83 Boulevard de l'Hôpital, Paris, France
| | - E Champion
- Department of Ophthalmology, Reference Centre for Rare Diseases, Hôpital Pitié-Salpêtrière, University Hospital Department of Vision and Disability, Pierre and Marie Curie University, Paris VI, 47-83 Boulevard de l'Hôpital, Paris, France
| | - N Massamba
- Department of Ophthalmology, Reference Centre for Rare Diseases, Hôpital Pitié-Salpêtrière, University Hospital Department of Vision and Disability, Pierre and Marie Curie University, Paris VI, 47-83 Boulevard de l'Hôpital, Paris, France
| | - P LeHoang
- Department of Ophthalmology, Reference Centre for Rare Diseases, Hôpital Pitié-Salpêtrière, University Hospital Department of Vision and Disability, Pierre and Marie Curie University, Paris VI, 47-83 Boulevard de l'Hôpital, Paris, France
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Maleki A, Meese H, Sahawneh H, Foster CS. Progress in the understanding and utilization of biologic response modifiers in the treatment of uveitis. Expert Rev Clin Immunol 2016; 12:775-86. [PMID: 26972783 DOI: 10.1586/1744666x.2016.1166052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Uveitis is the third most common cause of blindness in developed countries. Considering the systemic and local complications of long-term corticosteroid therapy and the intolerance due to side effects and ineffectiveness of conventional chemotherapy, use of biologic response modifiers is a reasonable alternative in the treatment of non-infectious uveitis and persistent uveitic macular edema. The majority of the evidence presented here comes from open uncontrolled analyses. Based on these studies, tumor necrosis factor alpha inhibitors, especially infliximab and adalimumab, have been shown to be effective in the treatment of non-infectious uveitis in numerous studies. More research is necessary, particularly multi-center randomized clinical trials, to address the choice of biologic response modifier agent and the length of treatment as we employ biologic response modifiers in different types of uveitis and persistent uveitic macular edema.
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Affiliation(s)
- Arash Maleki
- a Massachusetts Eye Research and Surgery Institution , Waltham , MA , USA.,b Ocular Immunology & Uveitis Foundation , Waltham , MA , USA
| | - Halea Meese
- a Massachusetts Eye Research and Surgery Institution , Waltham , MA , USA.,b Ocular Immunology & Uveitis Foundation , Waltham , MA , USA
| | - Haitham Sahawneh
- a Massachusetts Eye Research and Surgery Institution , Waltham , MA , USA.,b Ocular Immunology & Uveitis Foundation , Waltham , MA , USA
| | - C Stephen Foster
- a Massachusetts Eye Research and Surgery Institution , Waltham , MA , USA.,b Ocular Immunology & Uveitis Foundation , Waltham , MA , USA.,c Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
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Mérida S, Palacios E, Navea A, Bosch-Morell F. New Immunosuppressive Therapies in Uveitis Treatment. Int J Mol Sci 2015; 16:18778-95. [PMID: 26270662 PMCID: PMC4581271 DOI: 10.3390/ijms160818778] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/03/2015] [Accepted: 08/06/2015] [Indexed: 12/14/2022] Open
Abstract
Uveitis is an inflammatory process that initially starts in the uvea, but can also affect other adjacent eye structures, and is currently the fourth cause of blindness in developed countries. Corticoids are probably the most widespread treatment, but resorting to other immunosuppressive treatments is a frequent practice. Since the implication of different cytokines in uveitis has been well demonstrated, the majority of recent treatments for this disease include inhibitors or antibodies against these. Nevertheless, adequate treatment for each uveitis type entails a difficult therapeutic decision as no clear recommendations are found in the literature, despite the few protocolized clinical assays and many case-control studies done. This review aims to present, in order, the mechanisms and main indications of the most modern immunosuppressive drugs against cytokines.
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Affiliation(s)
- Salvador Mérida
- Instituto de Ciencias Biomédicas, Universidad CEU Cardenal Herrera, Valencia 46113, Spain.
| | - Elena Palacios
- Oftalmología Médica, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Valencia 46020, Spain.
| | - Amparo Navea
- Instituto de Ciencias Biomédicas, Universidad CEU Cardenal Herrera, Valencia 46113, Spain.
- Oftalmología Médica, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Valencia 46020, Spain.
| | - Francisco Bosch-Morell
- Instituto de Ciencias Biomédicas, Universidad CEU Cardenal Herrera, Valencia 46113, Spain.
- Oftalmología Médica, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Valencia 46020, Spain.
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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.
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Affiliation(s)
- Sirichai Pasadhika
- Department of Ophthalmology, Southern Arizona Veterans Administration Health Care System, Tucson, AZ, USA
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Zierhut M, Abu El-Asrar AM, Bodaghi B, Tugal-Tutkun I. Therapy of Ocular Behçet Disease. Ocul Immunol Inflamm 2013; 22:64-76. [DOI: 10.3109/09273948.2013.866257] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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O’Day R, Gillies MC, Ahlenstiel G. Ophthalmologic complications of antiviral therapy in hepatitis C treatment. World J Gastroenterol 2013; 19:8227-8237. [PMID: 24363513 PMCID: PMC3857445 DOI: 10.3748/wjg.v19.i45.8227] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 10/22/2013] [Indexed: 02/06/2023] Open
Abstract
Antiviral therapy consisting of interferon-alpha and ribavirin for chronic hepatitis C infection is associated with multi-system side-effects. Ophthalmologic complications are common and can be classified into two groups: interferon-associated retinopathy and atypical adverse events. Interferon-associated retinopathy has been investigated by multiple observational studies that have found widely divergent results. The clinical importance of this complication is, consequently, controversial. This review examines the literature with the specific goal of identifying the most important ophthalmologic issues facing the hepatologist prescribing antiviral therapy. Accordingly, it assesses the incidence of interferon-associated retinopathy, as well as its risk factors, pathogenesis, clinical manifestations and options for management using data from the observational studies. The likely benefit of a screening program, especially one targeting patients with the highest risk of developing interferon-associated retinopathy, is analysed. Atypical ophthalmologic adverse events occur less frequently than interferon-associated retinopathy during antiviral therapy for chronic hepatitis C infection. They often, however, lead to irreversible vision loss. We examine the reports of these adverse events - in individual case reports or case series and in the observational studies investigating interferon-associated retinopathy - to describe the spectrum of these adverse events, the likely outcome for patients and to highlight the most important areas of future clinical research.
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Mackensen F, Jakob E, Springer C, Dobner BC, Wiehler U, Weimer P, Rohrschneider K, Fiehn C, Max R, Storch-Hagenlocher B, Becker MD. Interferon versus methotrexate in intermediate uveitis with macular edema: results of a randomized controlled clinical trial. Am J Ophthalmol 2013; 156:478-486.e1. [PMID: 23786783 DOI: 10.1016/j.ajo.2013.05.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 05/01/2013] [Accepted: 05/02/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare interferon (IFN) beta with methotrexate (MTX) in the treatment of intermediate uveitis with macular edema. DESIGN Monocentric, prospective, randomized, controlled clinical trial. METHODS SETTING Specialized uveitis center at the University of Heidelberg. PATIENT OR STUDY POPULATION: Patients with either primary intermediate uveitis or uveitis associated with multiple sclerosis. MAIN INCLUSION CRITERIA: Visual acuity of 20/30 or worse (0.2 logarithm of the minimal angle of resolution) and macular edema of more than 250 μm (central 1-mm in optical coherence tomography; Stratus). Randomization into either IFN beta 44 μg subcutaneously 3 times weekly or 20 mg MTX subcutaneously once weekly. MAIN OUTCOME MEASURES At 3 months, the primary outcome parameter of mean change in visual acuity was evaluated and efficacy was determined. Secondary parameters were macular edema by optical coherence tomography, inflammatory activity, and retinal sensitivity by microperimetry (MP-1; Nidek). In case of treatment failure, switching to the other treatment arm was possible. RESULTS Nineteen patients were included. Ten were randomized to MTX, and 9 were randomized to IFN beta. At 3 months, visual acuity improved a mean 0.31 logarithm of the minimal angle of resolution (range, -0.02 to -0.96, 15.6 letters on the Early Treatment Diabetic Retinopathy Study chart) in the IFN beta group versus a mean 0.09 logarithm of the minimal angle of resolution (range, 0.12 to -0.38, 4.7 letters) in the MTX arm (P = .0435, Mann-Whitney U test). Macular thickness decreased by a mean of 206 μm (range, -41 to -416 μm) in the IFN arm, but increased by 47 μm (range, 108 to -28 μm) in the MTX group (P < .0001). CONCLUSIONS Although the sample size is small, results of the trial support superiority of IFN beta over MTX in the treatment of macular edema in the setting of intermediate uveitis.
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Buss G, Cattin V, Spring P, Malinverni R, Gilliet M. Two cases of interferon-alpha-induced sarcoidosis Koebnerized along venous drainage lines: new pathogenic insights and review of the literature of interferon-induced sarcoidosis. Dermatology 2013; 226:289-97. [PMID: 23886768 DOI: 10.1159/000346244] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 11/26/2012] [Indexed: 11/19/2022] Open
Abstract
Sarcoidosis is a systemic granulomatous disorder of unknown origin commonly affecting the lung, the lymphoid system and the skin. We report here two cases of cutaneous sarcoidosis in two former intravenous drug users following interferon (IFN)-α and ribavirin therapy for chronic hepatitis C. Both patients developed skin sarcoidosis along venous drainage lines of both forearms, coinciding with the areas of prior drug injections. The unique distribution of the skin lesions suggests that tissue damage induced by repeated percutaneous drug injections represents a trigger for the local skin manifestation of sarcoidosis. Interestingly, skin damage was recently found to induce the local expression IFN-α, a well-known trigger of sarcoidosis in predisposed individuals. Here we review the literature on sarcoidosis elicited in the context of IFN-α therapy and propose a new link between the endogenous expression of IFN-α and the induction of disease manifestations in injured skin.
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Affiliation(s)
- G Buss
- Division of Immunology and Allergology, University of Lausanne, Lausanne, Switzerland
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Cunningham ET, Pasadhika S, Suhler EB, Zierhut M. Drug-induced inflammation in patients on TNFα inhibitors. Ocul Immunol Inflamm 2012; 20:2-5. [PMID: 22324894 DOI: 10.3109/09273948.2011.644383] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Bodaghi B, Touitou V, Fardeau C, Chapelon C, LeHoang P. Ocular sarcoidosis. Presse Med 2012; 41:e349-54. [PMID: 22595776 DOI: 10.1016/j.lpm.2012.04.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 04/03/2012] [Indexed: 11/19/2022] Open
Affiliation(s)
- Bahram Bodaghi
- University of Pierre-and-Marie-Curie, Pitié-Salpêtrière Hospital, DHU Vision and Handicaps, Department of Ophthalmology, 75013 Paris, France.
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Unilateral ocular sarcoidosis associated with interferon therapy. Tzu Chi Med J 2011. [DOI: 10.1016/j.tcmj.2011.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
PURPOSE To compare the evidence base and systemic treatment strategies for sarcoidosis. METHODS Medline and EMBASE literature search on "sarcoidosis AND treatment", "sarcoidosis AND uveitis AND treatment", and "sarcoidosis AND eye AND treatment". The search was limited to randomized controlled trials (RCTs) and meta-analyses. RESULTS A total of 19 RCTs for the systemic treatment of extraocular sarcoidosis were identified. The majority were on corticosteroid-oral and inhaled. There were two meta-analyses on corticosteroid, including a Cochrane review. Only two RCTs were indentified for the treatment of intraocular sarcoidosis, one on etanercept, and the other from 1967 on prednisolone or oxyphenbutazone vs. placebo. There were no meta-analyses. Due to the paucity of RCTs other treatment studies were included but these were limited to only a few immunosuppressive agents and on small numbers of patients. CONCLUSION Limited high-quality evidence exists for the systemic treatment of sarcoidosis, in particular intraocular disease.
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Stübiger N, Winterhalter S, Pleyer U, Doycheva D, Zierhut M, Deuter C. [Janus-faced?: Effects and side-effects of interferon therapy in ophthalmology]. Ophthalmologe 2011; 108:204-12. [PMID: 21350868 DOI: 10.1007/s00347-010-2261-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Interferon alpha (IFN-α) and interferon beta (IFN-β) are naturally occurring cytokines, which belong to the type I interferons and share the same receptor leading to very similar therapeutic effects. The immunomodulatory effect of type I interferons includes modulation of antibody production, inhibition of lymphocyte proliferation, inhibition of delayed-type hypersensitivity and enhancement of T-cell and NK-cell cytotoxicity. An increasing number of open clinical studies and case reports have demonstrated the efficacy of IFN-α for severe ocular inflammation in patients with Behçet's disease and of interferon-β, which has been used mainly for the treatment of multiple sclerosis.
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Affiliation(s)
- N Stübiger
- Augenklinik, Charite Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland.
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Gayet AR, Plaisance P, Bergmann JF, Mouly S. Development of sarcoidosis following completion of treatment for hepatitis C with pegylated interferon-{alpha}2a and ribavirin: a case report and literature review. Clin Med Res 2010; 8:163-7. [PMID: 20852086 PMCID: PMC3006563 DOI: 10.3121/cmr.2010.886] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sarcoidosis is a chronic inflammatory multisystem disease of unknown etiology. We report on a woman, aged 57 years, presenting with typical sarcoidosis occurring two months after completion of a six-month course of interferon-α and ribavirin for chronic hepatitis C virus infection. The current observation is interesting with regard to the time elapsed between the occurrence of symptoms and antiviral treatment withdrawal, and spontaneous recovery after ten months of follow-up. Pathophysiological mechanisms involved in the development of antiviral therapy-induced sarcoidosis are discussed.
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Affiliation(s)
- Albéric-Rembrandt Gayet
- Emergency Department, Assistance Publique-Hôpitaux de Paris, Lariboisière Hospital, Paris, France.
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Abstract
UNLABELLED BASIC: To describe the main characteristics and treatment of sarcoidosis in patients with chronic hepatitis C virus (HCV) infection. METHODS Retrospective cohort study of patients with chronic HCV infection and sarcoidosis at our tertiary institution. RESULTS Eleven cases (eight women, three men) fulfilled the criteria for sarcoidosis. Four cases belong to our population of 3194 (0.12%) HCV patients seen in our department between 2001 and 2008. In five cases, sarcoidosis was triggered by antiviral therapy (consisted of interferon-alpha monotherapy in one case and combined therapy with interferon-alpha and ribavirin in four cases) and developed from 23 to 82 months after completion of therapy in three cases. For these patients, pulmonary adenopathies were found in three patients while two presented cutaneous involvement, one had uveitis and one presented both arthritis and extrapulmonary lymphadenopathies. Two patients received systemic corticosteroids with a favourable outcome. Four treatment-naive patients developed sarcoidosis. Two had pulmonary disease, one had medullar involvement, one had superficial lymphadenopathy and one had arthralgia. Three patients received systemic corticosteroids with chronic outcome in all cases. One of the two patients with an earlier history of sarcoidosis experienced a benign relapse that resolved spontaneously. CONCLUSION Clinical manifestations of sarcoidosis may occur in HCV patients, especially during or after treatment with immunotherapy. In our experience, sarcoidosis triggered by antiviral therapy was more frequent after completion of therapy, but concording with literature, presented a benign outcome. In sarcoidosis, seen in treatment-naive HCV patients, systemic corticosteroids had to be used more often and outcome was less favourable.
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Ballonzoli L, Bourcier T. [Ocular side effects of steroids and other immunosuppressive agents]. Therapie 2010; 65:115-20. [PMID: 20478243 DOI: 10.2515/therapie/2010002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 01/02/2010] [Indexed: 11/20/2022]
Abstract
The increasing use of immunosuppressive (IS) drugs in transplants or in systemic diseases, implies a long period of treatment and to be aware of possible side effects. These drugs can be used alone or in combination with steroids. This review deals with the issue of ocular side effects of the most used IS drugs, including steroids. Data were collected from Medline using Pubmed software. We first describe specific complication of each drug and then conclude on major common toxicity represented by opportunistic infections and induced cancers.
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Mackensen F, Max R, Becker MD. Interferons and their potential in the treatment of ocular inflammation. Clin Ophthalmol 2009; 3:559-66. [PMID: 19898628 PMCID: PMC2770867 DOI: 10.2147/opth.s3308] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Indexed: 12/31/2022] Open
Abstract
Since their discovery in the 1950s interferons have been the scope of investigation in many diseases as therapeutic as well as pathogenetic factors. We know they have immune stimulatory and immune regulatory effects. This apparently counter-intuitive mechanism can be summarized as immunomodulatory action and seems to be very effective in a number of ocular inflammatory diseases. We review the current knowledge of interferons in immunity and autoimmunity and show their use in clinical ophthalmologic practice.
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Affiliation(s)
- Friederike Mackensen
- Interdisciplinary Uveitis Center, Dept. of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, Heidelberg, Germany.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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