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Pleyer U, Pavesio C, Miserocchi E, Heinz C, Devonport H, Llorenç V, Burke T, Nogueira V, Kodjikian L, Bodaghi B. Fluocinolone acetonide 0.2 µg/day intravitreal implant in non-infectious uveitis affecting the posterior segment: EU expert user panel consensus-based clinical recommendations. J Ophthalmic Inflamm Infect 2024; 14:22. [PMID: 38814386 PMCID: PMC11139823 DOI: 10.1186/s12348-024-00402-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/02/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Non-infectious uveitis affecting the posterior segment of the eye (NIU-PS) is an inflammatory disease, which can significantly impair visual acuity if not adequately treated. Fluocinolone-acetonide sustained-release-0.2 µg/day intravitreal (FAc) implants are indicated for prevention of relapse in recurrent NIU-PS. The aim here was to provide treating clinicians with some consensus-based-recommendations for the clinical management of patients with NIU-PS with 0.2 µg/day FAc implants. METHODS A European-clinical-expert-group agreed to develop a consensus report on different issues related to the use of FAc implants in patients with NIU-PS. RESULTS The Clinical-expert-panel provided specific recommendations focusing on clinical presentation (unilateral/bilateral) of the NIU-PS; systemic involvement of NIU-PS and the lens status. Treatment algorithms were developed; one that refers to the management of patients with NIU-PS in clinical practice and another that establishes the best clinical scenarios for the use of FAc implants, both as monotherapy and as adjuvant therapy. Additionally, the Clinical-expert-panel has provided recommendations about the use of the FAc implants in a clinical-setting. The Clinical-expert-panel also considered the safety profile of FAc implants and their possible implications in the daily practice. CONCLUSIONS As more clinical experience has been gained using FAc implants, it was necessary to update the clinical recommendations that guide patient management in the clinic. The current consensus document addresses relevant issues related to the use of FAc implants on different types of patients with various etiologies of NIU-PS, and was conducted to standardize approaches to help specialists obtain better clinical outcomes.
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Affiliation(s)
- Uwe Pleyer
- Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Carlos Pavesio
- Department of Ophthalmology at Moorfields Eye Hospital, London, UK
| | - Elisabetta Miserocchi
- Department of Ophthalmology, Ocular Immunology and Uveitis Service, University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carsten Heinz
- Department of Ophthalmology at St, Franziskus Hospital Muenster, Münster, Germany
- Department of Ophthalmology, University Duisburg-Essen, Essen, Germany
| | - Helen Devonport
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, West Yorkshire, UK
| | - Víctor Llorenç
- Clínic Hospital of Barcelona, Barcelona, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Tomás Burke
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Vanda Nogueira
- Instituto de Oftalmologia Dr. Gama Pinto, Lisbon, Portugal
| | - Laurent Kodjikian
- Service d'Ophtalmologie, Hôpital Universitaire de La Croix-Rousse, Hospices Civils de Lyon, 69004, Lyon, France
- UMR5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, 69100, Villeurbanne, France
| | - Bahram Bodaghi
- Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France
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De Man V, Bataillie S, Cassiman C, Sels L, Schauwvlieghe PP. Ophthalmological and Neurological Findings in Patients with Idiopathic Uveitis Associated with Retinal Vasculitis and the Relation with the HLA DR15 Allele. Ocul Immunol Inflamm 2024:1-7. [PMID: 38648262 DOI: 10.1080/09273948.2024.2316759] [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: 04/21/2023] [Accepted: 02/05/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE In 15 patients with idiopathic uveitis associated with retinal vasculitis, HLA DRB1 gene testing was performed to detect a possible association. 11 patients tested positive and 4 negative for the HLA DRB1 × 15 allele. The presence of the HLA DRB1 × 15 haplotype might be associated with a higher susceptibility to develop Multiple Sclerosis (MS). METHODS In this case series, we describe the ophthalmological and neurological findings in 10 HLA DR15-positive patients and 4 HLA DR15-negative patients that had neurological workup, including Magnetic Resonance Imaging (MRI) of the brain. RESULTS All patients had granulomatous ocular inflammation with either panuveitis or intermediate uveitis. MRI of the brain showed white matter lesions in 13 patients (9/10 and 4/4 respectively) of which 4 patients were eventually diagnosed with MS (3/10 and 1/4 respectively). CONCLUSION Although the majority of tested patients was carrying at least one HLA DRB1-15 allele, there was no difference in ophthalmological and neurological findings in both groups.
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Affiliation(s)
- Vincent De Man
- Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Lise Sels
- Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
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Pichi F, Smith SD, Goldstein DA, Baddar D, Gerges TKA, Janetos TM, Ruiz-Cruz M, Elena Concha-Del-Río L, Maruyama K, Carina Ten Berge J, Rombach SM, Cimino L, Bolletta E, Miserocchi E, Scandale P, Serafino M, Camicione P, Androudi S, Gonzalez-Lopez JJ, Lim LL, Singh N, Gupta V, Gupta N, Amer R, Dodds EM, Inchauspe S, Munk MR, Donicova E, Carreño E, Takeuchi M, Chee SP, Chew MC, Agarwal A, Schlaen A, Gómez RA, Couto CA, Khairallah M, Neri P. The Humira in Ocular Inflammations Taper (HOT) Study. Am J Ophthalmol 2024; 258:87-98. [PMID: 37734639 DOI: 10.1016/j.ajo.2023.09.012] [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: 06/12/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE To assess factors that impact the risk of relapse in patients with noninfectious uveitis (NIU) who undergo adalimumab tapering after achieving remission. DESIGN Retrospective study. METHODS In this multicenter study, patients with NIU were treated with adalimumab and subsequently tapered. Patient demographics, type of NIU, onset and duration of disease, the period of inactivity before tapering adalimumab, and the tapering schedule were collected. The primary outcome measures were independent predictors of the rate of uveitis recurrence after adalimumab tapering. RESULTS Three hundred twenty-eight patients were included (54.6% female) with a mean age of 34.3 years. The mean time between disease onset and initiation of adalimumab therapy was 35.2 ± 70.1 weeks. Adalimumab tapering was commenced after a mean of 100.8 ± 69.7 weeks of inactivity. Recurrence was observed in 39.6% of patients at a mean of 44.7 ± 61.7 weeks. Patients who experienced recurrence were significantly younger than those without recurrence (mean 29.4 years vs 37.5 years, P = .0005), and the rate of recurrence was significantly higher in younger subjects (hazard ratio [HR] = 0.88 per decade of increasing age, P = .01). The lowest rate of recurrence was among Asian subjects. A faster adalimumab taper was associated with an increased recurrence rate (HR = 1.23 per unit increase in speed, P < .0005). Conversely, a more extended period of remission before tapering was associated with a lower rate of recurrence (HR = 0.97 per 10-weeks longer period of inactivity, P = .04). CONCLUSIONS When tapering adalimumab, factors that should be considered include patient age, race, and duration of disease remission on adalimumab. A slow tapering schedule is advisable.
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Affiliation(s)
- Francesco Pichi
- From the Eye Institute (F.P., S.D.S., A.A., P.N.), Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine (F.P., S.D.S., A.A., P.N.), Case Western Reserve University , Cleveland, Ohio, USA.
| | - Scott D Smith
- From the Eye Institute (F.P., S.D.S., A.A., P.N.), Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine (F.P., S.D.S., A.A., P.N.), Case Western Reserve University , Cleveland, Ohio, USA
| | - Debra A Goldstein
- Department of Ophthalmology (D.A.G., T.M.J.), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dina Baddar
- Watany Eye Hospital (D.B., T.K.A.G.), Cairo, Egypt; Research Institute of Ophthalmology (D.B.), Giza, Egypt
| | | | - Timothy M Janetos
- Department of Ophthalmology (D.A.G., T.M.J.), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matilde Ruiz-Cruz
- Asociación Para Evitar la Ceguera en México (M.R-C., L.E.C.), I. A. P., Mexico City, Mexico
| | | | - Kazuichi Maruyama
- Department of Vision Informatics (K.M.), Graduate School of Medicine, Osaka University, Osaka, Japan; Institute for Open and Transdisciplinary Research Initiatives (K.M.), Integrated Frontier Research for Medical Science Division, Osaka University, Osaka, Japan
| | - Josianne Carina Ten Berge
- Department of Ophthalmology (J.C.), Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Saskia M Rombach
- Department of Internal Medicine, Allergy and Clinical Immunology (S.M.R.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Luca Cimino
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine (L.C.), University of Modena and Reggio Emilia, Reggio Emilia, Italy; Ocular Immunology Unit (L.C., E.B.), Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Elena Bolletta
- Ocular Immunology Unit (L.C., E.B.), Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Elisabetta Miserocchi
- School of Medicine (E.M., P.S.), Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology (E.M., P.S.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierluigi Scandale
- School of Medicine (E.M., P.S.), Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology (E.M., P.S.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimiliano Serafino
- Department of Surgical Science (M.S., P.C.), Division of Ophthalmology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Paola Camicione
- Department of Surgical Science (M.S., P.C.), Division of Ophthalmology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sofia Androudi
- Department of Ophthalmology (S.A.), University of Thessaly, Thessaly, Greece
| | - Julio J Gonzalez-Lopez
- Ophthalmology Department (J.J.G-L.), Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Lyndell L Lim
- Centre for Eye Research Australia (L.L.L., N.S.), Royal Victorian Eye and Ear Hospital, University of Melbourne, Victoria, Australia
| | - Nandini Singh
- Centre for Eye Research Australia (L.L.L., N.S.), Royal Victorian Eye and Ear Hospital, University of Melbourne, Victoria, Australia
| | - Vishali Gupta
- Advance Eye Center (V.G., N.G.), Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nikita Gupta
- Advance Eye Center (V.G., N.G.), Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Radgonde Amer
- Department of Ophthalmology (R.A.), Hadassah Medical Center, Jerusalem, Israel
| | - Emilio M Dodds
- Consultores Oftalmológicos (E.M.D., S.I.), Buenos Aires, Argentina
| | | | - Marion R Munk
- Inselspital (M.R.M., E.D.), University Hospital Bern, Bern, Switzerland; Augenarzt-Praxisgemeinschaft Gutblick AG (M.R.M.), Bern, Switzerland; Feinberg School of Medicine (M.R.M.), Northwestern University, Chicago, Illinois, USA
| | - Emilia Donicova
- Inselspital (M.R.M., E.D.), University Hospital Bern, Bern, Switzerland
| | - Ester Carreño
- Hospital Universitario Fundación Jiménez Díaz (E.C.), Madrid, Spain
| | - Masaru Takeuchi
- Department of Ophthalmology (M.T.), National Defense Medical College, Namiki Tokorozawa Saitama, Japan
| | - Soon-Phaik Chee
- Singapore National Eye Centre (S-P.C., M.C.C.), Singapore; Department of Ophthalmology (S-P.C., M.C.C.), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Eye Research Institute (S-P.C.), Singapore; Department of Ophthalmology and Visual Sciences Academic Clinical Program (S-P.C.), Duke-NUS Medical School, Singapore
| | - Milton C Chew
- Singapore National Eye Centre (S-P.C., M.C.C.), Singapore; Department of Ophthalmology (S-P.C., M.C.C.), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Aniruddha Agarwal
- From the Eye Institute (F.P., S.D.S., A.A., P.N.), Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine (F.P., S.D.S., A.A., P.N.), Case Western Reserve University , Cleveland, Ohio, USA
| | - Ariel Schlaen
- Hospital Universitario Austral (A.S.), Buenos Aires, Argentina; Hospital De Clinicas "José de San Martín" (A.S., R.A.G., C.A.C.), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Ramiro A Gómez
- Hospital De Clinicas "José de San Martín" (A.S., R.A.G., C.A.C.), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Cristobal A Couto
- Hospital De Clinicas "José de San Martín" (A.S., R.A.G., C.A.C.), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Moncef Khairallah
- Department of Ophthalmology (M.K.), Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Tunisia
| | - Piergiorgio Neri
- From the Eye Institute (F.P., S.D.S., A.A., P.N.), Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine (F.P., S.D.S., A.A., P.N.), Case Western Reserve University , Cleveland, Ohio, USA
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Rituximab for non-infectious Uveitis and Scleritis. J Ophthalmic Inflamm Infect 2021; 11:23. [PMID: 34396463 PMCID: PMC8364894 DOI: 10.1186/s12348-021-00252-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/18/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose To provide a comprehensive review of rituximab use for the treatment of non-infectious uveitis and scleritis. Methods Review of literature through December 2020. Results Individual data was available for 229 patients with refractory non-infectious uveitis (n = 108) or scleritis (n = 121) who received treatment with rituximab (RTX). Rituximab was generally utilized as third-line or later treatment (uveitis: 67/90, 74.4%; scleritis: 90/96, 93.8%) at a mean of 33.5 months following the diagnosis of uveitis (range = 0 to 168.0 months; median = 24.0 months) and 39.4 months after diagnosis of scleritis (range = 1.0 to 168.0 months; median = 21.0 months). Patients with non-infectious uveitis and scleritis either received prior treatment with corticosteroids only (uveitis: 18/90, 20%; scleritis: 4/94, 4.3%), or with one (uveitis: 19/90, 21.1%; scleritis: 30/94, 31.9%), two (uveitis: 11/90, 12.2%; scleritis 27/94, 28.7%), or three or more (uveitis: 37/90, 41.1%; scleritis: 31/94, 33.0%) corticosteroid-sparing immunosuppressive agents with or without corticosteroids before initiation of RTX treatment. The rheumatologic protocol (two infusions of 1 gram of RTX separated by 14 days) was utilized most frequently (uveitis: 45/87, 51.7%; scleritis: 87/114, 76.3%), followed by the Foster protocol (eight weekly infusions of 375 mg/m2 RTX; uveitis: 18/87, 20.7%; scleritis: 10/114, 8.8%), and the oncologic protocol (four weekly infusions of 375 mg/m2 RTX; uveitis: 5/87, 5.7%; scleritis: 6/114, 5.3%). Various other off-label regimens were used infrequently (uveitis: 19/87, 21.8%; scleritis 11/114, 9.6%). Rituximab treatments resulted in a positive therapeutic response for the majority of patients with non-infectious uveitis (81/97, 83.5%). Commonly treated uveitic diagnoses included non-paraneoplastic autoimmune retinopathy (30/107, 28.0%), juvenile idiopathic arthritis (21/107, 19.6%), Vogt-Koyanagi-Harada disease (12/107, 11.2%), and Behçet disease (11/107, 10.3%). Cases of non-infectious scleritis were most commonly attributed to granulomatosis with polyangiitis (75/121, 62.0%) and rheumatoid arthritis (15/121, 12.4%), and showed an even greater rate of positive therapeutic response (112/120, 93.3%) following RTX treatment. No side effects were reported in 76.3% (74/97) of uveitis and 85.5% (71/83) scleritis cases. Of those cases associated with RTX-induced adverse events, the most common were infusion reactions of various severity (11/35, 31.4%). Conclusions Overall, RTX appeared to be both effective and well-tolerated as second or third-line therapy for patients with non-infectious uveitis and scleritis.
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Gueudry J, Leclercq M, Saadoun D, Bodaghi B. Old and New Challenges in Uveitis Associated with Behçet's Disease. J Clin Med 2021; 10:jcm10112318. [PMID: 34073249 PMCID: PMC8198480 DOI: 10.3390/jcm10112318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 12/13/2022] Open
Abstract
Behçet’s disease (BD) is a systemic vasculitis disease of unknown origin occurring in young people, which can be venous, arterial or both, classically occlusive. Ocular involvement is particularly frequent and severe; vascular occlusion secondary to retinal vasculitis may lead to rapid and severe loss of vision. Biologics have transformed the management of intraocular inflammation. However, the diagnosis of BD is still a major challenge. In the absence of a reliable biological marker, diagnosis is based on clinical diagnostic criteria and may be delayed after the appearance of the onset sign. However, therapeutic management of BD needs to be introduced early in order to control inflammation, to preserve visual function and to limit irreversible structural damage. The aim of this review is to provide current data on how innovations in clinical evaluation, investigations and treatments were able to improve the prognosis of uveitis associated with BD.
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Affiliation(s)
- Julie Gueudry
- Department of Ophthalmology, Hôpital Charles Nicolle, F-76000 Rouen, France
- Correspondence: ; Tel.: +33-2-32-88-80-57
| | - Mathilde Leclercq
- Department of Internal Medicine, Hôpital Charles Nicolle, F-76000 Rouen, France;
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, Groupe Hospitalier Pitié-Salpêtrière, F-75013 Paris, France;
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005 Paris, France
- Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651 Paris, France
| | - Bahram Bodaghi
- Department of Ophthalmology, IHU FOReSIGHT, Sorbonne-AP-HP, Groupe Hospitalier Pitié-Salpêtrière, F-75013 Paris, France;
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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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Coste N, Bocquet A, Labarere J, Semecas R, Aptel F, Deroux A, Bouillet L, Chiquet C. Tolerance and efficacy of anti-TNF currently used for severe non-infectious uveitis. Autoimmun Rev 2021; 20:102752. [PMID: 33476820 DOI: 10.1016/j.autrev.2021.102752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Nicolas Coste
- Grenoble Alpes University, Grenoble, France; Department of Ophthalmology, Grenoble Alpes University Hospital, Grenoble, France
| | - Alexis Bocquet
- Department of Internal Medicine, Grenoble Alpes University Hospital, Grenoble, France
| | - José Labarere
- Quality of Care Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Univ. Grenoble Alpes, Grenoble F-38043, France
| | - Rachel Semecas
- Grenoble Alpes University, Grenoble, France; Department of Ophthalmology, Grenoble Alpes University Hospital, Grenoble, France; Hypoxia and Physiopathology Laboratory HP2, INSERM U1042, University Grenoble Alpes, Grenoble, France
| | - Florent Aptel
- Grenoble Alpes University, Grenoble, France; Department of Ophthalmology, Grenoble Alpes University Hospital, Grenoble, France; Hypoxia and Physiopathology Laboratory HP2, INSERM U1042, University Grenoble Alpes, Grenoble, France
| | - Alban Deroux
- Department of Internal Medicine, Grenoble Alpes University Hospital, Grenoble, France
| | - Laurence Bouillet
- Department of Internal Medicine, Grenoble Alpes University Hospital, Grenoble, France.
| | - Christophe Chiquet
- Grenoble Alpes University, Grenoble, France; Department of Ophthalmology, Grenoble Alpes University Hospital, Grenoble, France; Hypoxia and Physiopathology Laboratory HP2, INSERM U1042, University Grenoble Alpes, Grenoble, France
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Dermarkarian CR, Patel NA, Villegas VM, Harbour JW. Bilateral uveitis associated with nivolumab therapy for metastatic non-small cell lung cancer. Am J Ophthalmol Case Rep 2020; 18:100691. [PMID: 32322748 PMCID: PMC7168346 DOI: 10.1016/j.ajoc.2020.100691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 01/31/2019] [Accepted: 04/02/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose To report a case of bilateral uveitis secondary to intravenous nivolumab therapy in a patient with stage IV non-small cell lung cancer. Observations A 53-year-old male with stage IV non-small cell lung cancer presented with gradual onset of blurry vision in the left eye for nine days after completion of the first cycle of intravenous nivolumab chemotherapy. At initial presentation, best-corrected visual acuity was 20/25 in the right eye and 20/30 in the left eye. Slit lamp biomicroscopy examination of the left eye showed temporal injection of the conjunctiva and sclera, granulomatous keratic precipitates, and vitreous cells in the posterior segment. Imaging studies, including fundus photography, fluorescein angiography, fundus autofluorescence, optical coherence tomography, iridocyanine green angiography, and B scan ultrasonography, demonstrated acute inflammation in the posterior segment of the right eye and anterior, intermediate and posterior segments of the left eye. Nivolumab was discontinued and the patient received a course of corticosteroids resulting in resolution of visual complaints. The patient subsequently developed elevated and sustained intraocular pressures and decreased visual acuity in the left eye secondary to treatment complications. The patient was then lost to follow-up. Conclusions and Importance To our best knowledge, this is a rare case of bilateral uveitis secondary to intravenous nivolumab use and the sixteenth reported case of nivolumab-induced uveitis. Physicians should be aware of possible ocular complications associated with the use of nivolumab and provide prompt treatment when necessary.
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Affiliation(s)
| | - Nimesh A Patel
- Bascom Palmer Eye Institute And, University of Miami Miller School of Medicine 900 NW 17th Street, Miami, FL, 33136, USA
| | - Victor M Villegas
- Bascom Palmer Eye Institute And, University of Miami Miller School of Medicine 900 NW 17th Street, Miami, FL, 33136, USA
| | - J William Harbour
- Bascom Palmer Eye Institute And, University of Miami Miller School of Medicine 900 NW 17th Street, Miami, FL, 33136, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine 900 NW 17th Street, Miami, FL, 33136, USA
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Cunningham ET, Pavesio CE, Goldstein DA, Forooghian F, Zierhut M. Multiple Sclerosis-Associated Uveitis. Ocul Immunol Inflamm 2019; 25:299-301. [PMID: 28696171 DOI: 10.1080/09273948.2017.1334469] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Emmett T Cunningham
- a Department of Ophthalmology , California Pacific Medical Center , San Francisco , California , USA.,b Department of Ophthalmology , Stanford University School of Medicine , Stanford , California , USA.,c The Francis I. Proctor Foundation , UCSF School of Medicine , San Francisco , California , USA
| | - Carlos E Pavesio
- d Moorfields Eye Hospital and Biomedical Research Center , NHS Foundation Trust , London , UK
| | - Debra A Goldstein
- e Department of Ophthalmology , Northwestern Feinberg School of Medicine , Chicago , Illinois , USA
| | - Farzin Forooghian
- f Department of Ophthalmology , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Manfred Zierhut
- g Centre for Ophthalmology , University Tuebingen, Schleichstrasse , Tuebingen , Germany
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Biancardi AL, Troncoso LL, Moraes Jr HVD, Zaltman C. The optimal time to perform an ophthalmic examination of patients with inflammatory bowel disease. Intest Res 2019; 17:153-154. [PMID: 30541229 PMCID: PMC6361020 DOI: 10.5217/ir.2018.00147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/07/2018] [Indexed: 11/19/2022] Open
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Squires H, Poku E, Bermejo I, Cooper K, Stevens J, Hamilton J, Wong R, Denniston A, Pearce I, Quhill F. A systematic review and economic evaluation of adalimumab and dexamethasone for treating non-infectious intermediate uveitis, posterior uveitis or panuveitis in adults. Health Technol Assess 2018; 21:1-170. [PMID: 29183563 DOI: 10.3310/hta21680] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Non-infectious intermediate uveitis, posterior uveitis and panuveitis are a heterogeneous group of inflammatory eye disorders. Management includes local and systemic corticosteroids, immunosuppressants and biological drugs. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of subcutaneous adalimumab (Humira®; AbbVie Ltd, Maidenhead, UK) and a dexamethasone intravitreal implant (Ozurdex®; Allergan Ltd, Marlow, UK) in adults with non-infectious intermediate uveitis, posterior uveitis or panuveitis. DATA SOURCES Electronic databases and clinical trials registries including MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and the World Health Organization's International Clinical Trials Registry Platform were searched to June 2016, with an update search carried out in October 2016. REVIEW METHODS Review methods followed published guidelines. A Markov model was developed to assess the cost-effectiveness of dexamethasone and adalimumab, each compared with current practice, from a NHS and Personal Social Services (PSS) perspective over a lifetime horizon, parameterised with published evidence. Costs and benefits were discounted at 3.5%. Substantial sensitivity analyses were undertaken. RESULTS Of the 134 full-text articles screened, three studies (four articles) were included in the clinical effectiveness review. Two randomised controlled trials (RCTs) [VISUAL I (active uveitis) and VISUAL II (inactive uveitis)] compared adalimumab with placebo, with limited standard care also provided in both arms. Time to treatment failure (reduced visual acuity, intraocular inflammation, new vascular lesions) was longer in the adalimumab group than in the placebo group, with a hazard ratio of 0.50 [95% confidence interval (CI) 0.36 to 0.70; p < 0.001] in the VISUAL I trial and 0.57 (95% CI 0.39 to 0.84; p = 0.004) in the VISUAL II trial. The adalimumab group showed a significantly greater improvement than the placebo group in the 25-item Visual Function Questionnaire (VFQ-25) composite score in the VISUAL I trial (mean difference 4.20; p = 0.010) but not the VISUAL II trial (mean difference 2.12; p = 0.16). Some systemic adverse effects occurred more frequently with adalimumab than with placebo. One RCT [HURON (active uveitis)] compared a single 0.7-mg dexamethasone implant against a sham procedure, with limited standard care also provided in both arms. Dexamethasone provided significant benefits over the sham procedure at 8 and 26 weeks in the percentage of patients with a vitreous haze score of zero (p < 0.014), the mean best corrected visual acuity improvement (p ≤ 0.002) and the percentage of patients with a ≥ 5-point improvement in VFQ-25 score (p < 0.05). Raised intraocular pressure and cataracts occurred more frequently with dexamethasone than with the sham procedure. The incremental cost-effectiveness ratio (ICER) for one dexamethasone implant in one eye for a combination of patients with unilateral and bilateral uveitis compared with limited current practice, as per the HURON trial, was estimated to be £19,509 per quality-adjusted life-year (QALY) gained. The ICER of adalimumab for patients with mainly bilateral uveitis compared with limited current practice, as per the VISUAL trials, was estimated to be £94,523 and £317,547 per QALY gained in active and inactive uveitis respectively. Sensitivity analyses suggested that the rate of blindness has the biggest impact on the model results. The interventions may be more cost-effective in populations in which there is a greater risk of blindness. LIMITATIONS The clinical trials did not fully reflect clinical practice. Thirteen additional studies of clinically relevant comparator treatments were identified; however, network meta-analysis was not feasible. The model results are highly uncertain because of the limited evidence base. CONCLUSIONS Two RCTs of systemic adalimumab and one RCT of a unilateral, single dexamethasone implant showed significant benefits over placebo or a sham procedure. The ICERs for adalimumab were estimated to be above generally accepted thresholds for cost-effectiveness. The cost-effectiveness of dexamethasone was estimated to fall below standard thresholds. However, there is substantial uncertainty around the model assumptions. In future work, primary research should compare dexamethasone and adalimumab with current treatments over the long term and in important subgroups and consider how short-term improvements relate to long-term effects on vision. STUDY REGISTRATION This study is registered as PROSPERO CRD42016041799. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Hazel Squires
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Edith Poku
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Inigo Bermejo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katy Cooper
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - John Stevens
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jean Hamilton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ruth Wong
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Ian Pearce
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Fahd Quhill
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Gueudry J, Thorne JE, Bansie R, Braun J, van Hagen PM, Bodaghi B. Biologic Therapy for HLA-B27-associated Ocular Disorders. Ocul Immunol Inflamm 2016; 25:169-178. [DOI: 10.1080/09273948.2016.1234625] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Julie Gueudry
- Department of Ophthalmology, Charles Nicolle University Hospital, Rouen, France
| | - Jennifer E. Thorne
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Rakesh Bansie
- Department of Clinical Immunology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Juergen Braun
- Department of Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany
| | - P. Martin van Hagen
- Department of Clinical Immunology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Bahram Bodaghi
- Department of Ophthalmology, University of Paris, VI Pitié-Salpêtrière Hospital, Paris, France
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Abstract
INTRODUCTION Drug-induced uveitis is a well described but often overlooked and/or misdiagnosed adverse reaction to medication. There are an increasing number of medications that have been related to the onset of intraocular inflammation. Identification of these inciting agents may decisively help the diagnostic algorithm involving new cases of uveitis. AREAS COVERED This review intends to be an updated comprehensive, practical guide for practitioners regarding the main drugs that have been associated with uveitis. A classification proposed by Naranjo et al. in 1981 for establishing potential causality is applied examining possible mechanisms of action. A guide for clinicians about the rationale of these observations when dealing with patients with uveitis is provided. EXPERT OPINION Several agents with different routes of administration (systemic, topical and/or intraocular) may cause intraocular inflammation. The mechanism behind ocular inflammation is frequently unknown. Clinicians should be aware of the potential drug effect to optimize diagnosis and management of such patients.
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Affiliation(s)
- Miguel Cordero-Coma
- Department of Ophthalmology, University Hospital of León , León , Spain +34 987237400 ; +34 987233322 ;
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Cunningham ET, Gupta A, Zierhut M. The Creeping Choroiditides – Serpiginous and Multifocal Serpiginoid Choroiditis. Ocul Immunol Inflamm 2014; 22:345-8. [DOI: 10.3109/09273948.2014.962924] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Day A, Abramson AK, Patel M, Warren RB, Menter MA. The spectrum of oculocutaneous disease. J Am Acad Dermatol 2014; 70:821.e1-19. [DOI: 10.1016/j.jaad.2013.12.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/18/2013] [Accepted: 12/29/2013] [Indexed: 11/27/2022]
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Cunningham ET, Zierhut M. The promise and limitations of TNF-α inhibition for uveitis. Ocul Immunol Inflamm 2014; 22:87-9. [PMID: 24689529 DOI: 10.3109/09273948.2014.894766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Cunningham ET. Treatment of chronic noninfectious uveitis in children--the trend toward tumor necrosis factor-alpha inhibition. J AAPOS 2013; 17:451-3. [PMID: 24160960 DOI: 10.1016/j.jaapos.2013.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 09/03/2013] [Indexed: 11/24/2022]
Affiliation(s)
- Emmett T Cunningham
- California Pacific Medical Center, San Francisco, California; Department of Ophthalmology, Stanford University School of Medicine, Stanford, California; West Coast Retina Medical Group, San Francisco, California.
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London NJS, Garg SJ, Moorthy RS, Cunningham ET. Drug-induced uveitis. J Ophthalmic Inflamm Infect 2013; 3:43. [PMID: 23522744 PMCID: PMC3637087 DOI: 10.1186/1869-5760-3-43] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 03/13/2013] [Indexed: 01/21/2023] Open
Abstract
A number of medications have been associated with uveitis. This review highlights both well-established and recently reported systemic, topical, intraocular, and vaccine-associated causes of drug-induced uveitis, and assigns a quantitative score to each medication based upon criteria originally described by Naranjo and associates.
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Affiliation(s)
- Nikolas JS London
- Retina Consultants San Diego, 9850 Genesee Avenue, Suite 700, La Jolla, CA, 92037, USA
| | - Sunir J Garg
- MidAtlantic Retina, The Retina Service of Wills Eye Institute, Thomas Jefferson University, 840 Walnut Street, Suite 1020, Philadelphia, PA, 19107, USA
| | - Ramana S Moorthy
- Associated Vitreoretinal and Uveitis Consultants, St. Vincent Hospital and Health Services, Indianapolis, IN, 46260, USA
- Associate Clinical Professor of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Emmett T Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, 94115, USA
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, 94305-5101, USA
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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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Cunningham ET, Goldstein DA, Zierhut M. Uveitis Treatment Trials—A Cross-study Perspective. Ocul Immunol Inflamm 2012; 20:63-7. [PMID: 22360435 DOI: 10.3109/09273948.2012.661297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Martel JN, Esterberg E, Nagpal A, Acharya NR. Infliximab and Adalimumab for Uveitis. Ocul Immunol Inflamm 2012; 20:18-26. [DOI: 10.3109/09273948.2011.633205] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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