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Li B, Li H, Huang Q, Zheng Y. Optimizing glucocorticoid therapy for Behçet's uveitis: efficacy, adverse effects, and advances in combination approaches. Int Ophthalmol 2023; 43:4373-4381. [PMID: 37420127 PMCID: PMC10520171 DOI: 10.1007/s10792-023-02808-w] [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: 05/07/2023] [Accepted: 06/29/2023] [Indexed: 07/09/2023]
Abstract
Behçet's uveitis (BU) is a debilitating manifestation of Behçet's disease, often requiring prompt and aggressive treatment to prevent vision loss. Glucocorticoids (GCS) serve as a first-line therapy for BU; however, their long-term, high-dose use can result in significant adverse effects. This review summarizes the efficacy, adverse effects, and advances in combination therapy involving GCS for the management of BU. We discuss the benefits and drawbacks of various GCS administration routes, including periocular and intravitreal injections, intravitreal sustained-release devices, and systemic therapy, highlighting the role of fluocinolone acetonide and dexamethasone as primary sustained-release formulations. Moreover, we underscore the importance of combining GCS with immunosuppressive drugs and biological agents to minimize adverse reactions and optimize therapeutic outcomes. The review concludes that, while GCS remain a crucial component of BU treatment, careful consideration of their administration and combination with other therapies is essential to achieve long-term remission and improved visual outcomes for patients with BU.
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Affiliation(s)
- Biao Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Haoran Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qun Huang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yanlin Zheng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Zhong Z, Su G, Yang P. Risk factors, clinical features and treatment of Behçet's disease uveitis. Prog Retin Eye Res 2023; 97:101216. [PMID: 37734442 DOI: 10.1016/j.preteyeres.2023.101216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023]
Abstract
Behçet's disease is a systemic vasculitis frequently associated with intraocular inflammation. Recent findings identified independent clinical clusters in Behçet's disease, each involving distinct combinations of affected organs. Ocular Behçet's disease, mainly manifested as uveitis, is characterized as an independent cluster with a low likelihood of association with other system involvements, such as intestinal, cardiovascular, or central nervous system. A prevailing theory suggests that the pathogenesis of the disease is multifactorial, where a variety of genetic and infectious agents may interact with each other to cause the disease. Among sporadic cases, the human leukocyte antigen (HLA) genes, including HLA-B51, HLA-A26, HLA-B15, and HLA-B5701, have been found to be a key component conferring genetic susceptibility. Outside the HLA region, a set of susceptibility variants are identified, closely related to interleukin (IL)-23/IL-17 pathway, tumor necrosis factor (TNF) signaling, and pattern recognition receptor systems. Microbial infections, such as Streptococcus sanguinis, Mycobacterium tuberculosis, and Herpes simplex virus (HSV), are linked to play the triggering of disease in immunogenetically predisposed individuals. Clinically, due to the notable relapsing-remitting course of ocular Behçet's disease, the prevention of recurrent attack would be the primary treatment goal. Combination of corticosteroids and immunomodulatory drugs, such as anti-TNF agents, interferon, and conventional immunosuppressants (e.g. cyclosporine, azathioprine), have been the mainstream regimen for the disease. Future research may focus on comparing the effectiveness of immunomodulatory drugs and identifying the most suitable subgroups for a specific drug on the basis of the knowledge of the molecular heterogeneity of the disease.
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Affiliation(s)
- Zhenyu Zhong
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China.
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Tao T, Yang S, He D, Li Z, Chen B, Zhu L, Su W. Intravitreal dexamethasone implants facilitate the management of refractory Behçet's uveitis with vasculitis. Clin Immunol 2023; 251:109633. [PMID: 37150241 DOI: 10.1016/j.clim.2023.109633] [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: 02/01/2023] [Revised: 04/07/2023] [Accepted: 04/28/2023] [Indexed: 05/09/2023]
Abstract
To investigate the efficacy and safety of dexamethasone (DEX) implant, Ozurdex ®, as an adjunctive treatment for refractory Behçet's uveitis (BU), a total of 61 patients (80 eyes) were included in this cross-sectional study and divided into the non-DEX and DEX groups. After >12 months of treatment, the improvement in the fluorescein angiography score and vitritis score was significantly higher in the DEX group than in the non-DEX group. Although the posterior capsule opacification score was exacerbated, the rate of low-dose systemic glucocorticoid was higher and the relapse times were fewer in the DEX group. Therefore, Ozurdex® is an effective and safe option for patients with BU that are refractory to systemic immunosuppressant treatments by controlling vasculitis, stabilizing vitreous inflammation, preventing recurrence, and reducing daily glucocorticoid doses.
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Affiliation(s)
- Tianyu Tao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Shizhao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China; Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daquan He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Zhaohuai Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Binyao Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Lei Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Wenru Su
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China.
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Tugal-Tutkun I, Çakar Özdal P. Behçet's disease uveitis: is there a need for new emerging drugs? Expert Opin Emerg Drugs 2020; 25:531-547. [PMID: 33147420 DOI: 10.1080/14728214.2020.1847271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Behçet's disease uveitis (BDU) is a potentially blinding disorder. Systemic treatment with disease-modifying anti-rheumatic drugs (DMARDs) is mandatory in patients with intraocular inflammation involving the posterior segment of the eye. Areas covered: This article discusses existing systemic treatment with corticosteroids and conventional and biologic DMARDs as well as adjunctive local therapy in BDU. An overview is provided for a wide range of biologic DMARDs that have shown promise or investigated in clinical trials. Most recently introduced biologic DMARDs and targeted synthetic DMARDs are also reviewed for their potential in the treatment of BDU. Expert opinion: The prognosis of patients with BDU has remarkably improved after the introduction of biologic DMARDs. An expanding therapeutic armamentarium will allow treatment of most refractory cases. The ultimate goal is to provide drug-free remission with preservation of 20/20 vision.
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Affiliation(s)
- Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University , Istanbul, Turkey
| | - Pinar Çakar Özdal
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Education and Research Hospital , Ankara, Turkey
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Local (topical and intraocular) therapy for ocular Adamantiades−Behçetʼs disease. Curr Opin Ophthalmol 2015; 26:546-52. [DOI: 10.1097/icu.0000000000000210] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Coşkun E, Celemler P, Kimyon G, Öner V, Kisacik B, Erbagci I, Onat AM. Intravitreal Dexamethasone Implant for Treatment of Refractory Behçet Posterior Uveitis: One-year Follow-up Results. Ocul Immunol Inflamm 2015; 23:437-43. [PMID: 26470764 DOI: 10.3109/09273948.2015.1042167] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the results of dexamethasone (DEX) implant in the treatment of eyes with refractory Behçet posterior uveitis. METHODS A total of 17 eyes of 12 patients with active Behçet posterior uveitis were enrolled in the study. A single intravitreal injection of DEX implant was applied to each eye. Best corrected visual acuity (BCVA), central macular thickness (CMT), vitreous haze score, and intraocular pressure (IOP) were determined, at baseline and control visits of months 1, 3, 6, and 12. RESULTS The mean BCVA was significantly increased from baseline at each control visit (all p < 0.05). The mean CMT and vitreous haze score were significantly decreased from baseline at each control visit (all p < 0.05). Three eyes showed IOP spikes requiring topical anti-glaucomatous treatment. CONCLUSIONS A single injection of DEX implant was safe and effective, as an additional treatment to systemic immunomodulatory drugs, in the treatment of refractory Behçet posterior uveitis, for a 6-month period.
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Affiliation(s)
- Erol Coşkun
- a Department of Ophthalmology , Gaziantep University Medicine School , Gaziantep , Turkey
| | - Pelin Celemler
- a Department of Ophthalmology , Gaziantep University Medicine School , Gaziantep , Turkey
| | - Gezmis Kimyon
- c Gaziantep University Medicine School, Department of Rheumatology , Gaziantep , Turkey
| | - Veysi Öner
- b Recep Tayyip Erdoğan University Medicine School, Department of Ophthalmology , Rize , Turkey , and
| | - Bunyamin Kisacik
- c Gaziantep University Medicine School, Department of Rheumatology , Gaziantep , Turkey
| | - Ibrahim Erbagci
- a Department of Ophthalmology , Gaziantep University Medicine School , Gaziantep , Turkey
| | - Ahmet Mesut Onat
- c Gaziantep University Medicine School, Department of Rheumatology , Gaziantep , Turkey
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Freitas-Neto CA, Maghsoudlou A, Dhanireddy S, Payal A, Boonsopon S, Ratwatte MD, Foster CS. Outcome of Multiple Implants and Dissociation of Fluocinolone Acetonide Intravitreal Implant (Retisert) in a Series of 187 Consecutive Implants. Ocul Immunol Inflamm 2014; 23:425-9. [PMID: 25541739 DOI: 10.3109/09273948.2014.986583] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate outcomes of long-term follow-up of Retisert multiple implantation and dissociation in eyes with chronic noninfectious uveitis. METHODS Review of 187 consecutive Retisert implants. Outcomes of multiple implantation and spontaneous medication pellet-strut dissociation were evaluated. RESULTS A total of 187 consecutive Retisert implants were reviewed. Eight implants were removed. The prevalence of spontaneous dissociation was 2.6% (5/187). The rate of dissociation increased to 11.11% (2/18) in cases of multiple implants. The mean period between Retisert implantation and spontaneous dissociation was 65.05 months. The mean period between implants in the same eye was 55.25 months. In cases of multiple implantations the old implant was not removed and 17.64% (3/17) of eyes required glaucoma filtering surgery. CONCLUSION The rate of spontaneous dissociation of Retisert medication pellet-strut in eyes with single implant for noninfectious uveitis is low, which tends to increase in eyes with multiple implants.
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Affiliation(s)
- Clovis Arcoverde Freitas-Neto
- a Massachusetts Eye Research and Surgery Institution , Cambridge , Massachusetts , USA .,b Ocular Immunology and Uveitis Foundation , Cambridge , Massachusets , USA .,c Hospital de Olhos Santa Luzia , Recife-PE , Brazil , and
| | - Armin Maghsoudlou
- a Massachusetts Eye Research and Surgery Institution , Cambridge , Massachusetts , USA .,b Ocular Immunology and Uveitis Foundation , Cambridge , Massachusets , USA
| | - Swetha Dhanireddy
- a Massachusetts Eye Research and Surgery Institution , Cambridge , Massachusetts , USA .,b Ocular Immunology and Uveitis Foundation , Cambridge , Massachusets , USA
| | - Abhishek Payal
- a Massachusetts Eye Research and Surgery Institution , Cambridge , Massachusetts , USA .,b Ocular Immunology and Uveitis Foundation , Cambridge , Massachusets , USA
| | - Sutasinee Boonsopon
- a Massachusetts Eye Research and Surgery Institution , Cambridge , Massachusetts , USA .,b Ocular Immunology and Uveitis Foundation , Cambridge , Massachusets , USA
| | - Malinga D Ratwatte
- a Massachusetts Eye Research and Surgery Institution , Cambridge , Massachusetts , USA .,b Ocular Immunology and Uveitis Foundation , Cambridge , Massachusets , USA
| | - C Stephen Foster
- a Massachusetts Eye Research and Surgery Institution , Cambridge , Massachusetts , USA .,b Ocular Immunology and Uveitis Foundation , Cambridge , Massachusets , USA .,d Harvard Medical School , Cambridge , Massachusetts , USA
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