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Fink DJ, Dell J, Heinz C, Wintergerst MWM, Höller T, Berger M, Schmid M, Boden KT, Pleyer U, Reitsamer H, Deuter CME, Lohmann TK, Finger RP. Treatment exit options for non-infectious uveitis registry: participant characteristics at 3 years. Br J Ophthalmol 2024:bjo-2023-324927. [PMID: 38857972 DOI: 10.1136/bjo-2023-324927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/21/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE The Treatment exit Options For non-infectious Uveitis (TOFU) registry documents disease courses for non-anterior non-infectious uveitis entities with and without treatment to generate more evidence for clinical management recommendations including treatment exit strategies. In this article, we present the participants' baseline characteristics after the first 3 years. METHODS TOFU is an observational, prospective registry and recruits patients ≥18 years of age with non-anterior non-infectious uveitis with or without a history of previous disease-modifying antirheumatic drugs (DMARDs) treatment. The data are collected in the electronic data capture software REDCap and include ophthalmological and general medical history as well as clinical findings. RESULTS Between 24.10.2019 and 27.12.2022, 628 patients were enrolled at 25 clinical sites in Germany and Austria. Patients with intermediate uveitis were most frequently included (n=252; 40.1%) followed by posterior uveitis (181; 28.8%), panuveitis (n=154; 24.5%) and retinal vasculitis (n=41, 6.5%). At baseline, 39.6% were treated with systemic corticosteroids, 22.3% with conventional synthetic (cs) DMARDs, 20.5% with biological (b) DMARDs and 3.6% with other systemic treatments. Average best corrected visual acuity (BCVA) was 0.69 decimal. Patients with panuveitis had the worst BCVA with 0.63 decimal. Overall, only 8 patients (1.3%) suffered from severe visual impairment. CONCLUSIONS Less than half of participants required DMARD treatment at baseline, with csDMARDs used more frequently than bDMARDs. The presence of severe visual impairment was low, mostly affecting patients with panuveitis. These findings are in line with comparable monocentric cross-sectional studies of tertiary uveitis centres in Germany and will allow us to generate generalisable evidence in TOFU.
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Affiliation(s)
- David Julian Fink
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Jennifer Dell
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Carsten Heinz
- Department of Ophthalmology at St. Franziskus-Hospital Muenster, Muenster, Germany
- Department of Ophthalmology, University Duisburg-Essen, Essen, Germany
| | | | - Tobias Höller
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Moritz Berger
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Karl Thomas Boden
- Eye clinic, Knappschaftsklinikum Saar GmbH Krankenhaus, Sulzbach, Germany
| | - Uwe Pleyer
- Department of Ophthalmology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Herbert Reitsamer
- University Hospital Salzburg for Ophthalmology and Optometry, Salzburg, Austria
| | | | - Tibor K Lohmann
- Department of Ophthalmology, University Hospital RWTH Aachen, Aachen, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
- Department of Ophthalmology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Azzopardi M, Chong YJ, Sreekantam S, Barry RJ, Poonit N, Rauz S, Murray PI. Real-World Experience in the Use of Immunosuppression for the Management of Inflammatory Eye Disease. Ocul Immunol Inflamm 2024:1-10. [PMID: 38349962 DOI: 10.1080/09273948.2024.2311743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/24/2024] [Indexed: 02/15/2024]
Abstract
PURPOSE Patients with sight-threatening inflammatory eye disease (IED) are maintained on systemic immunosuppression whilst in long-term clinical remission. There are no clear guidelines on the duration of remission before implementing treatment withdrawal. We present a real-world analysis on the use of immunosuppression in IED in long-term remission and consider strategies for withdrawal. METHODS Adult IED patients on systemic immunosuppression were categorised into four disease groups: Corneal Transplant Survival Strategies (CTSS), Ocular Surface Disease (OSD), Non-infectious Uveitis (NIU) and Scleritis. Patients with Behçet's disease were excluded. Data on systemic immunosuppressants and biologics used; duration of treatment; reasons for drug discontinuation; disease activity/remission status; duration of clinical remission with an emphasis on patients who had been in remission for a minimum of 24 months were captured. RESULTS Out of a total of 303 IED patients, 128 were on systemic immunosuppression with a clinical remission of their ocular disease for ≥24 months. The median duration of remission was 4-5 years with the longest duration of remission 22 years, and some patients on immunosuppression for up to 23 years. Sixty patients stopped at least one immunosuppressive agent without prior discussion with a health-care practitioner. CONCLUSION Progressive conditions, such as cicatrising conjunctivitis may require lifelong immunosuppression, but patients with NIU and Scleritis and those on CTSS, immunosuppression withdrawal should be considered if they remain in remission for 2 years. Any patient stopping a medication should be contacted immediately for counselling. These data will better inform patients, encourage adherence and aide formal guideline development.
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Affiliation(s)
- Matthew Azzopardi
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Yu Jeat Chong
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Sreekanth Sreekantam
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Robert J Barry
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Natraj Poonit
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Saaeha Rauz
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Philip I Murray
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Abraham AR, Maghsoudlou P, Copland DA, Nicholson LB, Dick AD. CAR-Treg cell therapies and their future potential in treating ocular autoimmune conditions. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1184937. [PMID: 38983082 PMCID: PMC11182176 DOI: 10.3389/fopht.2023.1184937] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/03/2023] [Indexed: 07/11/2024]
Abstract
Ophthalmic autoimmune and autoinflammatory conditions cause significant visual morbidity and require complex medical treatment complicated by significant side effects and lack of specificity. Regulatory T cells (Tregs) have key roles in immune homeostasis and in the resolution of immune responses. Polyclonal Treg therapy has shown efficacy in treating autoimmune disease. Genetic engineering approaches to produce antigen-specific Treg therapy has the potential for enhanced treatment responses and fewer systemic side effects. Cell therapy using chimeric antigen receptor modified T cell (CAR-T) therapy, has had significant success in treating haematological malignancies. By modifying Tregs specifically, a CAR-Treg approach has been efficacious in preclinical models of autoimmune conditions leading to current phase 1-2 clinical trials. This review summarises CAR structure and design, Treg cellular biology, developments in CAR-Treg therapies, and discusses future strategies to apply CAR-Treg therapy in the treatment of ophthalmic conditions.
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Affiliation(s)
- Alan R. Abraham
- Ophthalmology Research Group, Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Panayiotis Maghsoudlou
- Ophthalmology Research Group, Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
- University of Bath, Bath, United Kingdom
| | - David A. Copland
- Ophthalmology Research Group, Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Lindsay B. Nicholson
- Ophthalmology Research Group, Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Andrew D. Dick
- Ophthalmology Research Group, Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
- UCL-Institute of Ophthalmology, University College London, London, United Kingdom
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Rivas AB, Lopez-Picado A, Calamia V, Carreño E, Cocho L, Cordero-Coma M, Fonollosa A, Francisco Hernandez FM, Garcia-Aparicio A, Garcia-Gonzalez J, Mondejar JJ, Lojo-Oliveira L, Martínez-Costa L, Munoz S, Peiteado D, Pinto JA, Rodriguez-Lozano B, Pato E, Diaz-Valle D, Molina E, Tebar LA, Rodriguez-Rodriguez L. Efficacy, safety and cost-effectiveness of methotrexate, adalimumab or their combination in non-infectious non-anterior uveitis: a protocol for a multicentre, randomised, parallel three arms, active-controlled, phase III open label with blinded outcome assessment study. BMJ Open 2022; 12:e051378. [PMID: 35318229 PMCID: PMC8943738 DOI: 10.1136/bmjopen-2021-051378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Non-infectious uveitis include a heterogeneous group of sight-threatening and incapacitating conditions. Their correct management sometimes requires the use of immunosuppressive drugs (ISDs), prescribed in monotherapy or in combination. Several observational studies showed that the use of ISDs in combination could be more effective than and as safe as their use in monotherapy. However, a direct comparison between these two treatment strategies has not been carried out yet. METHODS AND ANALYSIS The Combination THerapy with mEthotrexate and adalImumAb for uveitis (CoTHEIA) study is a phase III, multicentre, prospective, randomised, single-blinded with masked outcome assessment, parallel three arms with 1:1:1 allocation, active-controlled, superiority study design, comparing the efficacy, safety and cost-effectiveness of methotrexate, adalimumab or their combination in non-infectious non-anterior uveitis. We aim to recruit 192 subjects. The duration of the treatment and follow-up will last up to 52 weeks, plus 70 days follow-up with no treatment. The complete and maintained resolution of the ocular inflammation will be assessed by masked evaluators (primary outcome). In addition to other secondary measurements of efficacy (quality of life, visual acuity and costs) and safety, we will identify subjects' subgroups with different treatment responses by developing prediction models based on machine learning techniques using genetic and proteomic biomarkers. ETHICS AND DISSEMINATION The protocol, annexes and informed consent forms were approved by the Reference Clinical Research Ethic Committee at the Hospital Clínico San Carlos (Madrid, Spain) and the Spanish Agency for Medicines and Health Products. We will elaborate a dissemination plan including production of materials adapted to several formats to communicate the clinical trial progress and findings to a broad group of stakeholders. The promoter will be the only access to the participant-level data, although it can be shared within the legal situation. TRIAL REGISTRATION NUMBER 2020-000130-18; NCT04798755.
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Affiliation(s)
- Ana Belen Rivas
- Unidad de Investigación Clinica y Ensayos Clínicos, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Departamento de Enfermería. Facultad Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | - Amanda Lopez-Picado
- Unidad de Investigación Clinica y Ensayos Clínicos, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Valentina Calamia
- Unidad de Proteómica. Grupo de Investigación de Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, and Universidade da Coruña, A Coruna, Galicia, Spain
| | - Ester Carreño
- Department of Ophthalmology, University Hospital Fundacion Jimenez Diaz, and University Hospital Rey Juan Carlos, Madrid, Madrid, Spain
| | - Lidia Cocho
- Department of Ophthalmology, IOBA (Institute of Applied OphthalmoBiology), University of Valladolid, and Hospital Clínico Universitario de Valladolid, Valladolid, Castilla y León, Spain
| | - Miguel Cordero-Coma
- Uveitis Unit, University Hospital of León, IBIOMED, and University of León, Leon, Spain
| | - Alex Fonollosa
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, País Vasco, Spain
| | - Felix M Francisco Hernandez
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | | | - Javier Garcia-Gonzalez
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Comunidad de Madrid, Spain
| | - Jose Juan Mondejar
- Department of Ophthalmology, Hospital General Universitario de Alicante, Alicante, Comunidad Valenciana, Spain
| | | | - Llucí Martínez-Costa
- Department of Ophthalmology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Santiago Munoz
- Department of Rheumatology, Hospital Universitario Infanta Sofia, San Sebastian de los Reyes, Madrid, Spain
| | - Diana Peiteado
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Jose Antonio Pinto
- Department of Rheumatology, Complexo Hospitalario Universitario de A Coruña, A Coruna, Galicia, Spain
| | - Beatriz Rodriguez-Lozano
- Department of Rheumatology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Canarias, Spain
| | - Esperanza Pato
- Department of Rheumatology, Hospital Clínico San Carlos, IdISSC, Madrid, Madrid, Spain
| | - David Diaz-Valle
- Department of Ophthalmology, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Elena Molina
- Department of Pathology, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Luis Alberto Tebar
- Unidad de Investigación Clinica y Ensayos Clínicos, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Luis Rodriguez-Rodriguez
- Musculoskeletal Pathology Group, Fundacion para la Investigacion Biomedica del Hospital Clinico San Carlos, IdISSC, Madrid, Spain
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Research Progress on the Mechanism of Natural Product Ingredients in the Treatment of Uveitis. J Immunol Res 2021; 2021:6683411. [PMID: 34778467 PMCID: PMC8585548 DOI: 10.1155/2021/6683411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 06/16/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background As the spectrum of ophthalmic diseases keeps changing, uveitis has gradually become one of the major blinding eye diseases in the world. In recent years, it has become a research hotspot to select effective components for uveitis treatment from natural drugs. Methods We searched PubMed and EMBASE databases for studies written in English as well as Chinese National Knowledge Infrastructure (CNKI), CQVIP, and Wan Fang database for studies written in Chinese (inception through 30 December 2020). Results Eight kinds of natural product ingredients were included in this article. They were found to not only regulate the expression of cytokines, proliferation, and differentiation of T help cells but also inhibit the damage of cytokines and inflammatory cells to uvea, blood aqueous barrier, and blood retinal barrier. Conclusion Natural product ingredients have their unique advantages in the treatment of uveitis. They have good anti-inflammatory effects without causing serious adverse reactions, which enables them to be promising choices for preventive and therapeutic strategy of uveitis.
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Li JQ, Dell J, Höller T, Fink D, Schmid M, Heinz C, Finger RP. [The Treatment Exit Options for Uveitis (TOFU) Registry: Involving Patients in the Generation of Evidence]. DAS GESUNDHEITSWESEN 2021; 83:S39-S44. [PMID: 34731892 DOI: 10.1055/a-1630-6895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Uveitis comprises a group of rare diseases characterised by intraocular inflammation which may cause vision impairment and blindness and mostly affects people of working age. Non-infectious uveitis involving the posterior pole or the entire eye is often treated with different immunomodulating or disease-modifying anti-rheumatic drugs (DMARDs). However, the evidence on long-term management strategies and reduction/termination of treatment is limited. To help develop treatment exit strategies for patients with quiescent uveitis on long-term DMARD treatment, the Treatment Exit Options for Non-infectious Uveitis registry was initiated by the German ophthalmological society. A key aspect of the registry is active participation of patients (patient-reported outcomes, PROs). In a pilot study involving members of patient organizations, a combination of questionnaires covering vision- and general health-related quality of life, adherence to treatment, productivity and effects of treatment were evaluated. As the pilot study showed coverage of relevant patient-related aspects of the disease and its effect on daily life, the evaluated questionnaires were implemented in the registry's patient module. The registry including the patient module uses the electronic data capture (EDC) software REDCap (Version 9, Vanderbilt University, USA). By involving patients in both conceptualization and ongoing data collection, the TOFU registry emphasizes the patients' perspectives, and the inclusion of patient-relevant evidence for such as the development of guidelines and treatment recommendations is ensured.
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Affiliation(s)
- Jeany Q Li
- Augenheilkunde, Universität zu Köln Medizinische Fakultät, Köln, Deutschland.,Zentrum für Augenheilkunde, Uniklinik Köln, Köln, Deutschland
| | - Jennifer Dell
- Augenklinik, Universitätsklinikum Bonn Augenklinik, Bonn, Deutschland
| | - Tobias Höller
- Institut für Medizinische Biometrie Informatik und Epidemiologie, IMBIE, Universität Bonn, Bonn, Deutschland
| | - David Fink
- Augenklinik, Universitätsklinikum Bonn Augenklinik, Bonn, Deutschland
| | - Matthias Schmid
- Institut für Medizinische Biometrie Informatik und Epidemiologie, IMBIE, Universität Bonn, Bonn, Deutschland
| | - Carsten Heinz
- Augenzentrum, Augenzentrum am St Franziskus-Hospital Münster, Münster, Deutschland.,Augenklinik, Universitätsklinikum Essen, Essen, Deutschland
| | - Robert P Finger
- Augenklinik, Universitätsklinikum Bonn Augenklinik, Bonn, Deutschland
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Tang Lee Say TL, Yang V, Fingret JM, Zagora S, Symes R, Younan C, Cornish EE, Verma N, Sammel A, Wakefield D, Speden D, McCluskey PJ. Adalimumab in patients with vision-threatening uveitis: real-world clinical experience. BMJ Open Ophthalmol 2021; 6:e000819. [PMID: 34632076 PMCID: PMC8477319 DOI: 10.1136/bmjophth-2021-000819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/07/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives Biologics are rapidly emerging as an effective vision saving addition to systemic uveitis therapy. The aim of this multicentre retrospective study is to review the outcomes of a large group of patients treated with adalimumab. Methods A retrospective chart review of patients with refractory non-infectious, active uveitis treated with adalimumab was conducted. The main outcome measures were ability to reduce prednisolone dose, ability to control uveitis, final visual acuity and time to treatment failure. Results Forty-six patients with uveitis, treated with adalimumab were included in the study. The most common anatomical uveitis phenotype was panuveitis (n=17, 37.0%). The most common diagnosis was idiopathic uveitis (n=19, 41.3%). At their latest review (mean: 4.46 years; median 4.40 years), 35 (76.1%) patients were able to discontinue corticosteroids, 11 (23.9%) patients were able to taper to <7.5 mg/day and only 1 (2.2%) patient required 10 mg of prednisone. The mean visual acuity at the latest follow-up of the worse eye was logarithm of the minimum angle of resolution (logMAR) 0.42 (SD 0.72), while the mean visual acuity of the better eye was logMAR 0.19 (SD 0.34). Of the 89 eyes, 21 (23.6%) eyes improved by at least 2 lines, 5 eyes (5.6%) deteriorated by ≥2 lines while vision was unchanged in the remaining 63 (70.8%) eyes. The time to recurrence was 1 in 12.47 person-years for adalimumab, with a 17.4% (8 patient) relapse rate. There were no serious adverse events. Conclusions This study highlights the efficacy of adalimumab in patients with vision-threatening non-infectious uveitis, preserving vision and allowing reduction of corticosteroid dose.
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Affiliation(s)
- Timothy Lee Tang Lee Say
- Sydney Hospital and Sydney Eye Hospital, Sydney, New South Wales, Australia.,Cardinal Santos Medical Center, San Juan, Manila, Philippines
| | - Verlyn Yang
- Royal Hobart Hospital, Hobart, Tasmania, Australia.,Gold Coast Hospital and Health Service, Southport, Queensland, Australia.,University of Tasmania, Hobart, Tasmania, Australia
| | - Jacob M Fingret
- Sydney Hospital and Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Sophia Zagora
- Sydney Hospital and Sydney Eye Hospital, Sydney, New South Wales, Australia.,Saint Vincent's Hospital, Darlinghurst, New South Wales, Australia.,The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
| | - Richard Symes
- Sydney Hospital and Sydney Eye Hospital, Sydney, New South Wales, Australia.,The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
| | - Christine Younan
- Sydney Hospital and Sydney Eye Hospital, Sydney, New South Wales, Australia.,The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
| | - Elisa Eleanor Cornish
- Sydney Hospital and Sydney Eye Hospital, Sydney, New South Wales, Australia.,The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
| | - Nitin Verma
- Royal Hobart Hospital, Hobart, Tasmania, Australia.,University of Tasmania, Hobart, Tasmania, Australia.,East Timor Eye Program, Hobart, Tasmania, Australia
| | - Anthony Sammel
- Sydney Hospital and Sydney Eye Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Denis Wakefield
- Saint Vincent's Hospital, Darlinghurst, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | | | - Peter J McCluskey
- Sydney Hospital and Sydney Eye Hospital, Sydney, New South Wales, Australia.,Royal Hobart Hospital, Hobart, Tasmania, Australia.,Saint Vincent's Hospital, Darlinghurst, New South Wales, Australia.,The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
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Li JQ, Heinz C, Dell J, Schmid M, Finger RP. Treatment Exit Options for Non-infectious Uveitis (TOFU): Study Protocol for a Prospective Clinical Registry. Ophthalmic Epidemiol 2021; 29:31-38. [PMID: 33615986 DOI: 10.1080/09286586.2021.1887285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: Currently, there is limited evidence regarding clinical management of non-anterior non-infectious uveitis including treatment outcomes of disease-modifying anti-rheumatic drugs (DMARDs) and their combinations. Treatment guidelines or recommendations on preferred choice of DMARD combinations and reduction and/or discontinuation strategies in quiescent uveitis are lacking. The TOFU (Treatment exit options for non-infectious uveitis) registry aims to document disease courses and to provide recommendations on DMARD treatment exit strategies.Methods: The registry is an observational, non-commercial, and non-interventional study and targets patients who are ≥18 years of age with non-infectious uveitis of the posterior segment or retinal vasculitis on or starting DMARD treatment. Data are entered prospectively at study sites through a web-based interface into electronic case report forms (eCRF) implemented in the electronic data capture software RedCap (Version 9, Vanderbilt University, USA). The collated data include ophthalmological, general medical history and patient-reported outcomes (PROs). Assessment of uveitis classification and activity follows the international Standardization of uveitis nomenclature (SUN) criteria. Patient appointment and treatment decisions remain at the discretion of the managing physician and are completely independent of participation in the registry. The study follows the tenets of the declaration of Helsinki.Conclusions: The TOFU registry captures real-life data of patients with non-infectious uveitis of the posterior segment, involving both medical personnel and patients. The study adheres to international standards and will provide important evidence and guidance in the development of guidelines.
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Affiliation(s)
- Jeany Q Li
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Carsten Heinz
- Department of Ophthalmology, St. Franziskus Hospital Münster, Münster, Germany.,Department of Ophthalmology, University Duisburg-Essen, Essen, Germany
| | - Jennifer Dell
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
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Gaggiano C, Sota J, Gentileschi S, Caggiano V, Grosso S, Tosi GM, Frediani B, Cantarini L, Fabiani C. The current status of biological treatment for uveitis. Expert Rev Clin Immunol 2020; 16:787-811. [PMID: 32700605 DOI: 10.1080/1744666x.2020.1798230] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Noninfectious uveitis represents one of the leading causes of blindness in developed Countries, compromising patients' quality of life and social functioning. The main treatment goals are the control of ocular inflammation, to avert and treat sight-threatening complications, thus preserving and/or restoring visual function. AREAS COVERED This manuscript deals with systemic therapy with biologic drugs for noninfectious uveitis. An extensive literature search in the MEDLINE database (via PubMed) has been performed up to June 2020. The major classes of biologic molecules employed in ocular inflammatory diseases have been reviewed, focusing on TNF inhibitors, IL-1, IL-6, IL-17, IL-23 inhibitors, interferons, rituximab, and abatacept efficacy and safety. An overview of most recent developments in the field has been provided as well, with reference to the experience with JAK inhibitors and with biosimilar drugs. EXPERT OPINION The development of the concept of targeted therapy and the subsequent introduction of biologic molecules in clinical practice have revolutionized the prognosis of uveitis. The target of a rapid and sustained steroid-free remission of ocular inflammation should be pursued for all patients early in the disease course, in order to have a better chance to improve the final visual outcome.
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Affiliation(s)
- Carla Gaggiano
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy.,Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena , Siena, Italy
| | - Jurgen Sota
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy
| | - Stefano Gentileschi
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy.,Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy
| | - Valeria Caggiano
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena , Siena, Italy
| | - Gian Marco Tosi
- Ophthalmology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Italy
| | - Bruno Frediani
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy.,Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy
| | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy.,Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy
| | - Claudia Fabiani
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy.,Ophthalmology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Italy
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Millán-Longo C, Peiteado D, Schlincker A, Hidalgo V, Pieren A, Balsa A, de Miguel E. Use of Immunomodulatory Drugs at a Uveitis Clinic. REUMATOLOGIA CLINICA 2019; 15:271-276. [PMID: 29132749 DOI: 10.1016/j.reuma.2017.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/18/2017] [Accepted: 09/29/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The treatment of noninfectious uveitis includes steroids and immunomodulatory drugs, the use of which has increased in the last few years, and the options have been enriched with the development of new treatments. However, clear therapeutic guidelines and protocols have not been developed. The purpose is to analyze the response to the drugs used and the characteristics of the patients treated at a multidisciplinary uveitis clinic. MATERIAL AND METHODS Observational and retrospective study of the patients attended to from January 2012 to December 2015. Infectious, posttraumatic and postoperative uveitis, as well as masquerade syndrome, were excluded. RESULTS Two hundred six patients were included. Overall, 58.80% had uveitis without association of systemic disease, mostly idiopathic uveitis, and 35.65% had uveitis with systemic involvement, mainly related to spondyloarthritis. Uveitis without systemic association and anterior uveitis achieved disease control with local treatment more frequently than others (p=.002 and p <.001, respectively). In all, 49.76% of the patients required systemic treatment. Among those treated with immunomodulators, 53.26% needed a second drug and 31.52% needed a third drug. Women required immunomodulators more often than men (P=.042). Methotrexate was the most widely used immunomodulator. Posterior uveitis responded less favorably to the second immunomodulator than anterior uveitis (p=.006). CONCLUSIONS Almost half of the patients needed an immunomodulatory drug and some of them required successive drug changes. Intermediate uveitis was the most treatment-refractory uveitis.
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Affiliation(s)
| | - Diana Peiteado
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España
| | | | - Ventura Hidalgo
- Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, España
| | - Amara Pieren
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España
| | - Alejandro Balsa
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España
| | - Eugenio de Miguel
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España
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Yalcinbayir O, Caliskan E, Ucan Gunduz G, Gelisken O, Kaderli B, Yucel A. Efficacy of Dexamethasone Implants in Uveitic Macular Edema in Cases with Behçet Disease. Ophthalmologica 2018; 241:190-194. [DOI: 10.1159/000490674] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/06/2018] [Indexed: 11/19/2022]
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12
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Gómez-Gómez A, Loza E, Rosario MP, Espinosa G, de Morales JMGR, Herreras JM, Muñoz-Fernández S, Cordero-Coma M. Efficacy and safety of immunomodulatory drugs in patients with anterior uveitis: A systematic literature review. Medicine (Baltimore) 2017; 96:e8045. [PMID: 29049193 PMCID: PMC5662359 DOI: 10.1097/md.0000000000008045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/15/2017] [Accepted: 08/18/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To assess the efficacy and safety of immunomodulatory drugs in patients with noninfectious anterior uveitis (AU). METHODS Systematic review of studies were retrieved from Medline (1961 to March 2016), Embase (1961 to March 2016), and Cochrane Library (up to March 2016), and a complementary hand search was also performed. The selection criteria were as follows: (population) noninfectious AU patients, adults; (intervention) immunomodulatory drugs (any dose, regimen, route of administration, duration of treatment); (outcome) control of inflammation, steroid-sparing effect, AU flares, adverse events, and so on; (study design) systematic literature reviews, randomized controlled trials, and observational studies. The study quality was assessed using the Jadad scale and according to The Oxford Centre for Evidence-based Medicine (update 2009). RESULTS We included 13 studies of moderate-poor quality, with a mean duration from 5 months to 20 years, and number of AU patients ranging from 9 to 274. Patient's demographic and clinical characteristics were very heterogeneous. In most cases, uveitis anatomic classification criteria and outcomes definitions were unclear. Some of the studies only included AU patients with a systemic disease associated, mostly spondyloarthritis, others, mixed populations (idiopathic and systemic disease associated patients), and in some articles this data is not described. We found that methotrexate, cyclosporine A, azathioprine, adalimumab, and golimumab might prevent AU flares, improve ocular inflammation and visual acuity, and decrease systemic steroids doses. CONCLUSIONS Although there is a lack of robust evidence, methotrexate, cyclosporine A, azathioprine, adalimumab, and golimumab might be effective in AU patients.
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Affiliation(s)
- Alejandro Gómez-Gómez
- Reumatología HM Hospitales-Hospital Universitario HM Sanchinarro, Madrid
- Reumatología, Hospital Universitario Infanta Sofía, Madrid
| | | | | | - Gerard Espinosa
- Department of Autoimmune Diseases, Institut Clinic de Medicina i Dermatologia, Hospital Clínic, Barcelona
| | - José M. García Ruiz de Morales
- Unidad de Inmunología, Complejo Asistencial Universitario e Instituto de Biomedicina Universidad de León (IBIOMED), León
| | - Jose M. Herreras
- Instituto Universitario de Oftalmobiología (IOBA), Universitdad de Valladolid, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Hospital Clínico Universitario de Valladolid
| | | | - Miguel Cordero-Coma
- Unidad de Uveitis, Complejo Asistencial Universitario e Instituto de Biomedicina Universidad de León (IBIOMED), León, Spain
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Shirinsky IV, Biryukova AA, Shirinsky VS. Simvastatin as an Adjunct to Conventional Therapy of Non-infectious Uveitis: A Randomized, Open-Label Pilot Study. Curr Eye Res 2017; 42:1713-1718. [DOI: 10.1080/02713683.2017.1355468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ivan V. Shirinsky
- Laboratory of Clinical Immunopharmacology, Federal State Budgetary Scientific Institution Research Institute of Fundamental and Clinical Immunology, Novosibirsk, Russia
| | - Anastasia A. Biryukova
- Laboratory of Clinical Immunopharmacology, Federal State Budgetary Scientific Institution Research Institute of Fundamental and Clinical Immunology, Novosibirsk, Russia
- S. N. Fyodorov Eye Microsurgery Complex, Novosibirsk Branch, Novosibirsk, Russia
| | - Valery S. Shirinsky
- Laboratory of Clinical Immunopharmacology, Federal State Budgetary Scientific Institution Research Institute of Fundamental and Clinical Immunology, Novosibirsk, Russia
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Hanna KS. A Rare Case of Pembrolizumab-Induced Uveitis in a Patient with Metastatic Melanoma. Pharmacotherapy 2016; 36:e183-e188. [PMID: 27716999 DOI: 10.1002/phar.1839] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pembrolizumab, a programmed cell death protein 1 (PD-1) inhibitor, is a humanized monoclonal antibody used in the treatment of metastatic or unresectable melanoma and advanced non-small cell lung cancer (NSCLC). We hereby report a case of pembrolizumab-induced uveitis to increase practitioner awareness. A 78-year-old woman presented with onset of panuveitis after initiation of pembrolizumab therapy for metastatic melanoma. The patient received three cycles of therapy every 21 days, during which her symptoms progressively worsened. She was treated with topical and systemic corticosteroids, and further pembrolizumab was discontinued despite a good response to therapy. Pembrolizumab has been associated with rapid onset of ocular inflammation and uveitis. PD-1 inhibitors mediate a T-cell response against cancer cells; however, autoimmune complications have been reported. Incidence of pembrolizumab-induced uveitis is reported to be < 1%. To date, three cases have been reported since its Food and Drug Administration approval in September 2014. Uveitis, if left untreated, may lead to permanent vision loss and ocular damage. Cases of immune-mediated uveitis have been reported with cancer immunotherapies. Oncologists and ophthalmologists should be aware of this complication. With the increasing targeted pharmaceuticals in oncology, effective management of adverse events is necessary to ensure patient safety and optimal outcomes.
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Affiliation(s)
- Kirollos S Hanna
- Hematology/Oncology Clinical Pharmacist, Mayo Clinic, Rochester, Minnesota
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Abstract
Non-infectious uveitis mainly affects the working-age population and can contribute to significant social and economic burden. It comprises a heterogeneous group of conditions with varied aetiology. Precise and early diagnosis, excluding masquerade syndromes, is the key to early therapeutic intervention. Treatment should be appropriately selected according to the anatomical sites of inflammation, the diagnosis and known prognosis, and whether there is a systemic inflammatory drive. Corticosteroids in the form of local or systemic therapy form the mainstay of treatment; however, due to unacceptable side effects, the need for long-term use or suboptimal response, corticosteroid-sparing medications may need to be considered early on in the management of non-infectious uveitis. With newer insights into the immunopathology of uveitis and the availability of biologic agents, treatment can be tailored according to individual needs. Many patients have systemic involvement, and hence a multidisciplinary approach is often required to achieve the best outcome in an individual. Patient involvement in the management of non-infectious uveitis, ensuring compliance, and continual monitoring of both the treatment and therapeutic response are the key to achieving optimal outcomes.
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Abásolo L, Rosales Z, Díaz-Valle D, Gómez-Gómez A, Peña-Blanco RC, Prieto-García Á, Benítez-del-Castillo JM, Pato E, García-Feijoo J, Fernández-Gutiérrez B, Rodriguez-Rodriguez L. Immunosuppressive Drug Discontinuation in Noninfectious Uveitis From Real-Life Clinical Practice: A Survival Analysis. Am J Ophthalmol 2016; 169:1-8. [PMID: 27296486 DOI: 10.1016/j.ajo.2016.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/01/2016] [Accepted: 06/02/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess in uveitis patients the rate of immunosuppressive drug (ISD) discontinuation in real-life clinical practice, comparing this rate among ISDs. DESIGN Longitudinal retrospective cohort study. METHODS We included uveitis patients attending a tertiary eye referral center from Madrid (Spain) between 1989 and 2015, prescribed any ISDs (cyclosporine, methotrexate, azathioprine, anti-TNF drugs, or others). Our main outcome was discontinuation of all ISDs owing to clinical efficacy, inefficacy, adverse drug reaction (ADR), and other medical causes. Discontinuation rates (DRs) per 100 patient-years were estimated. Variables associated with specific-cause discontinuations were analyzed using Cox bivariate and multivariate models. RESULTS We analyzed 110 patients with 263 treatment courses and 665.2 patient-years of observation. Cyclosporine (66.4%), methotrexate (47.3%), azathioprine (30.9%), and anti-TNFs (30.9%) were the most frequently used ISDs. Treatment was suspended in 136 cases (mostly owing to clinical efficacy [38.2%], inefficacy [26.5%], and ADRs [22.8%]). All-cause DR with 95% confidence interval was 20.4 [17.3-24.2]. Retention rates at 1 and 10 years were 74% and 16%, respectively. In the multivariate analysis, combined treatment exhibited higher DRs owing to clinical efficacy than other ISDs in monotherapy. Conversely, nonbiologic combination therapy with azathioprine exhibited the highest DR owing to ADRs. CONCLUSIONS Clinical efficacy was the most frequent cause for ISD discontinuation, followed by inefficacy and ADRs. DR owing to efficacy was higher for combination therapy. Furthermore, nonbiologic combination therapy with azathioprine was associated with a higher DR owing to ADRs.
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Three cases of tubulointerstitial nephritis and uveitis syndrome with different clinical manifestations. Int Ophthalmol 2016; 37:753-759. [PMID: 27511057 PMCID: PMC5440544 DOI: 10.1007/s10792-016-0321-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 08/03/2016] [Indexed: 11/22/2022]
Abstract
We here describe three different clinical manifestations of tubulointerstitial nephritis and uveitis (TINU) syndrome. We examined and diagnosed the following 3 patients: a 15-year-old boy with bilateral anterior uveitis (Case 1), a 14-year-old girl with bilateral papilledema (Case 2), and a 49-year-old woman with panuveitis (Case 3). The findings are presented herein. Case 1: The patient had bilateral anterior uveitis. Urinalysis revealed markedly increased β2-microglobulin and N-acetyl-β-d-glucosaminidase levels. As the patient was pathologically diagnosed with tubulointerstitial nephritis (TIN), we diagnosed TINU based on the presence of both uveitis and TIN. He was treated with oral corticosteroids. Case 2: This patient showed anterior uveitis and papilledema in both eyes. On initial examination, the urine test results did not show any abnormality. Three months later, high β2-microglobulin and N-acetyl-β-d-glucosaminidase levels were detected. As the patient was clinically diagnosed with TIN, we subsequently diagnosed TINU. Both the ocular and renal findings improved without treatment. Case 3: The patient developed bilateral panuveitis, retinal vasculitis, and macular edema, which were initially suspected to be sarcoidosis. However, she was pathologically diagnosed with TIN 12 months before the onset of uveitis; therefore, she was finally diagnosed with TINU. She recovered with local corticosteroid administration only. TINU may present with fundal features in addition to anterior uveitis. Detailed history taking and urinalysis are important to determine the presence of tubular disorders in similar patients.
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Abstract
Multidisciplinary management in the diagnosis and management of patients with ocular inflammatory disease is often critical. The workup of uveitis or scleritis may reveal an underlying systemic disease. Recognition of inflammation by the primary care physician can facilitate prompt referral to a uveitis specialist and improve patient outcomes. The primary care physician can assist the ophthalmologist in monitoring for potential side effects of corticosteroids and immunosuppressive drugs, including the newer biologic agents. The ophthalmologist in turn can assist the primary care physician in recognizing that active uveitis may suggest incomplete control of preexisting conditions.
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Affiliation(s)
- James P Dunn
- Uveitis Unit, Retina Division, Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, 840 Walnut Street, Suite 1020, Philadelphia, PA 19107, USA.
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Joshi L, Tanna A, McAdoo SP, Medjeral-Thomas N, Taylor SR, Sandhu G, Tarzi RM, Pusey CD, Lightman S. Long-term Outcomes of Rituximab Therapy in Ocular Granulomatosis with Polyangiitis. Ophthalmology 2015; 122:1262-8. [DOI: 10.1016/j.ophtha.2015.01.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/10/2015] [Accepted: 01/17/2015] [Indexed: 12/12/2022] Open
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Schaal S, Reddy SV, Kaplan HJ. Current medical and surgical therapeutic approaches to cystoid macular edema in uveitis. EXPERT REVIEW OF OPHTHALMOLOGY 2015. [DOI: 10.1586/17469899.2015.1003042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
PURPOSE OF REVIEW Birdshot chorioretinopathy remains incompletely understood, but new insights into its pathogenesis have been reported recently, and treatment and monitoring options have also expanded. Central visual acuity may remain good until the late stages of the disease, but loss of visual field and peripheral retinal function is common. RECENT FINDINGS The underlying pathogenesis of the disease has long been believed to be T-cell driven, but examination of the IL-17 pathway has now further refined the potential underlying mechanism. New imaging techniques, including extended depth imaging of the choroid with optical coherence tomography, have demonstrated promise in detecting disease activity earlier, enabling targeted treatment to be given. Treatment options have expanded with the advent of the biological agents, and these may yet improve outcomes, particularly in refractory patients. SUMMARY Laboratory research continues to investigate the underlying mechanisms of disease, but our understanding remains frustratingly incomplete for a disease with such a clear HLA association. Clinical research is increasingly being driven to improve the phenotyping of affected patients so that those at risk of visual loss can be identified early and treated more aggressively with individually targeted therapies such as the newer biological agents, but how successful this approach will ultimately prove to be remains to be seen.
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