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Gil W, Kodjikian L, Andre M, Kaur I, Durel CA, Hot A, Fauter M, Chaigne B, Smets P, Samson M, Seve P. Uveitis in Giant Cell Arteritis: A Retrospective Study of Seven Observational Cases and Literature Review. Ocul Immunol Inflamm 2024; 32:1844-1851. [PMID: 37815855 DOI: 10.1080/09273948.2023.2264383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/23/2023] [Accepted: 09/23/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE To describe the demographic and clinical characteristics of uveitis in patients with giant cell arteritis (GCA), their treatments, and evolution. METHODS A national retrospective cohort study was performed. The inclusion criteria were as follows: patients with GCA fulfilling the 2022 ACR/EULAR criteria and a diagnostic of uveitis attested by an ophthalmologist. RESULTS Seven women were included. The median age at diagnosis of uveitis was 71 years (64-84). All uveitis were diagnosed during active GCA (five at initial diagnosis, two at relapse). All uveitis were acute (100%), mostly anterior (86%) and bilateral (71%). Granulomatous features were less common (29%). All uveitis were treated with local and systemic corticosteroids. After a median follow-up of 30 (21-55) months, all patients achieved complete ophthalmic remission, with only one relapse at 2 years. GCA was also in complete remission. CONCLUSIONS Uveitis could reveal GCA, and its presence correlated with disease activity of GCA. The most frequent clinical presentation of uveitis was acute and anterior; using local and systemic corticosteroids, the prognosis was favorable.
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Affiliation(s)
- William Gil
- Department of Internal Medicine, Hôpital Universitaire Gabriel-Montpied, Clermont-Ferrand, France
- Université Clermont-Auvergne, Clermont-Ferrand, France
| | - Laurent Kodjikian
- Department of Ophthalmology, Hôpital Universitaire Croix-Rousse, Lyon, France
- UMR5510 MATEIS, CNRS, INSA Lyon, Lyon, France
| | - Marc Andre
- Department of Internal Medicine, Hôpital Universitaire Gabriel-Montpied, Clermont-Ferrand, France
- Université Clermont-Auvergne, Clermont-Ferrand, France
| | | | - Cécile Audrey Durel
- Department of Internal Medicine, Hôpital Saint Joseph Saint Luc, Lyon, France
| | - Arnaud Hot
- UMR5510 MATEIS, CNRS, INSA Lyon, Lyon, France
- Department of Internal Medicine, Hôpital Universitaire Edouard Herriot, Lyon, France
| | - Maxime Fauter
- Department of Internal Medicine, Hôpital Universitaire Croix-Rousse, Lyon, France
| | - Benjamin Chaigne
- Department of Internal Medicine, Centre de Référence Maladies Auto-immunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
| | - Perrine Smets
- Department of Internal Medicine, Hôpital Universitaire Gabriel-Montpied, Clermont-Ferrand, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Hôpital Universitaire Dijon-Bourgogne, Dijon, France
| | - Pascal Seve
- Department of Internal Medicine, Hôpital Universitaire Croix-Rousse, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
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Jacquot R, Kodjikian L, Chapurlat R, Sève P. Targeted therapies for uveitis in spondyloarthritis: A narrative review. Joint Bone Spine 2024; 91:105697. [PMID: 38309516 DOI: 10.1016/j.jbspin.2024.105697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/01/2024] [Accepted: 01/23/2024] [Indexed: 02/05/2024]
Abstract
Spondyloarthritis (SpA) encompasses a group of chronic inflammatory disorders of the joints frequently associated with uveitis in almost a quarter of cases. SpA-related uveitis typically affects the eye anterior chamber with sudden onset, causing pain, redness, photophobia, and blurred vision. Ophthalmologists will describe an acute anterior unilateral uveitis. Most patients present with episodic acute anterior non-granulomatous uveitis and retain excellent visual acuity. However, systemic treatments are recommended in the event of frequent relapses (2-3/year) or in rare cases of sight-threatening with ocular complications. The improved understanding of the pathogenesis of SpA has led to the management of this disease by biologics. Here, we review the main data regarding the opportunity to target specific components in inflammatory pathways for the treatment of SpA-related uveitis. These therapies are recommended for long-term control when uveitis relapses occur too frequently despite conventional systemic treatments. Significant benefits have been obtained with the tumor necrosis factor-α inhibitors (TNFis), particularly infliximab and adalimumab. Paradoxically, a high number of uveitis occurrences have been shown on etanercept. Mixed results have been demonstrated with interleukin-17 antagonists (secukinumab) and interleukin-12/interleukin-23 antagonists (ustekinumab) in cases of failure of TNFis. JAK inhibitors seem to be a valuable class of medications for these patients in the future. Although SpA-related uveitis is typically managed with conventional local and/or systemic treatments, these biological/targeted therapies may provide avenues to control both the underlying SpA and uveitis manifestations. Thus, a close collaboration between patients, rheumatologists, internists, and ophthalmologists is needed to optimally manage ocular inflammation in SpA.
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Affiliation(s)
- Robin Jacquot
- Department of Internal Medicine, Hospices Civils de Lyon, Hôpital Universitaire de la Croix-Rousse, University Claude-Bernard Lyon 1, Lyon, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), University Claude-Bernard Lyon 1, Lyon, France.
| | - Laurent Kodjikian
- Department of Ophthalmology, Hospices Civils de Lyon, Hôpital Universitaire de la Croix-Rousse, University Claude-Bernard Lyon 1, Lyon, France; UMR5510 MATEIS, CNRS, INSA Lyon, University Claude-Bernard Lyon 1, Villeurbanne, France
| | - Roland Chapurlat
- Department of Rheumatology, Hospices Civils de Lyon, Hôpital Universitaire Édouard-Herriot, University Claude-Bernard Lyon 1, Lyon, France
| | - Pascal Sève
- Department of Internal Medicine, Hospices Civils de Lyon, Hôpital Universitaire de la Croix-Rousse, University Claude-Bernard Lyon 1, Lyon, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), University Claude-Bernard Lyon 1, Lyon, France
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Lopalco G, Cito A, Venerito V, Iannone F, Proft F. The management of axial spondyloarthritis with cutting-edge therapies: advancements and innovations. Expert Opin Biol Ther 2024; 24:835-853. [PMID: 39109494 DOI: 10.1080/14712598.2024.2389987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 08/05/2024] [Indexed: 08/28/2024]
Abstract
INTRODUCTION Axial involvement in spondyloarthritis has significantly evolved from the original 1984 New York criteria for ankylosing spondylitis, leading to an improved understanding of axial spondyloarthritis (axSpA) as a disease continuum encompassing non- radiographic axSpA (nr-axSpA) and radiographic axSpA (r-axSpA). A clear definition for early axSpA has been established, underscoring the need for early intervention with biological and targeted synthetic drugs to mitigate pain, reduce functional impairment, and prevent radiographic progression. AREAS COVERED This review explores therapeutic strategies in axSpA management, focusing on biological and targeted synthetic therapies and recent advancements. Biologics targeting TNFα or IL-17 and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) are primary treatment options. These therapies significantly impact clinical outcomes, radiographic progression, and patient-reported functional improvement. EXPERT OPINION AxSpA treatment has evolved significantly, offering various therapeutic options. Biological DMARDs, particularly TNFα inhibitors, have transformed treatment, significantly enhancing patient outcomes. However, challenges persist for patients unresponsive or intolerant to existing therapies. Emerging therapeutic targets promise to address these challenges. Comprehensive management strategies and personalized approaches, considering extra-articular manifestations and individual patient factors, are crucial for achieving optimal outcomes in axSpA management.
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Affiliation(s)
- Giuseppe Lopalco
- Department of Precision Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, Bari, Italy
| | - Andrea Cito
- Department of Precision Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, Bari, Italy
| | - Vincenzo Venerito
- Department of Precision Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, Bari, Italy
| | - Florenzo Iannone
- Department of Precision Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, Bari, Italy
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Garweg JG, Straessle KA. Janus Kinase Inhibitors as a Third-Line Therapy for Refractory Endogenous Noninfectious Uveitis. Ocul Immunol Inflamm 2024:1-8. [PMID: 38709218 DOI: 10.1080/09273948.2024.2348125] [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: 10/26/2023] [Accepted: 04/23/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE Janus kinase (JAK) inhibitors have recently been used to treat patients with biologic refractory noninfectious uveitis (NIU). This narrative review updates the current evidence relevant for their application in patients with refractory NIU. METHODS A literature search was performed for articles published until October 2023 in the PubMed, Scopus, and CENTRAL databases using the key terms "noninfectious uveitis" and "Janus kinase inhibitor" or "JAK inhibitor" without any exclusion criteria. Published articles were selected based on their clinical focus, relevance for ocular disease, time since publication and study design reflecting their scientific soundness with a critical appraisal of drug safety aspects. RESULTS Janus kinases are transmembrane signaling proteins. Their inhibition has shown therapeutic potential experimentally and in patients with multiple immune-mediated diseases, including NIU. JAK inhibitors differ from biological agents in that they inhibit not one specific but multiple cytokines. These agents can be ingested orally and seem superior to adalimumab for most indications. While there is no doubt regarding their efficacy in treating immune-mediated inflammatory diseases, reports regarding their safety are increasing, and the findings are generally confusing and contradictory. Since substantiated information about their specific safety profiles in patients with inflammatory eye disease is lacking, their position in the therapeutic algorithm for uveitis has yet to be determined. CONCLUSIONS In the absence of evidence from controlled clinical trials, JAK inhibitor therapy is still rendered experimental and currently considered only for sight-threatening uveitis. JAK inhibitors may be considered for specific NIU entities for which there is insufficient response or secondary loss of response to conventional or biologic disease-modifying drugs.
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Affiliation(s)
- Justus G Garweg
- Swiss Eye Institute and Clinic for Vitreoretinal Diseases, Berner Augenklinik, Bern, Switzerland
- Department of Ophthalmology, Inselspital, Medical Faculty, University of Bern, Bern, Switzerland
| | - Kim A Straessle
- Swiss Eye Institute and Clinic for Vitreoretinal Diseases, Berner Augenklinik, Bern, Switzerland
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Hijazi N, Gazitt T, Haddad A, Elias M, Kassem S, Feldhamer I, Cohen AD, Sar S, Tomkins-Netzer O, Saliba W, Zisman D. The risk factors for uveitis among psoriatic arthritis patients: a population-based cohort study. Clin Rheumatol 2024; 43:1053-1061. [PMID: 38082206 DOI: 10.1007/s10067-023-06834-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/09/2023] [Accepted: 11/26/2023] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To assess the frequency of uveitis in patients with psoriatic arthritis (PsA) in the era of biologics and to identify risk factors associated with uveitis. METHODS A retrospective matched cohort study was conducted within the database of a large healthcare provider. Newly diagnosed 6147 adult PsA patients between 2005 and 2020 were matched by the index date of PsA diagnosis, age, sex, and ethnicity to 23,999 randomly selected controls. This cohort was used to examine the association between PsA and uveitis. An additional analysis was conducted within the PsA group to identify uveitis risk factors, using two analytic approaches: a retrospective cohort study and a nested case-control study. RESULTS Uveitis was diagnosed in 107 patients in the PsA group (1.7%) vs 187 (0.8%) patients in the control group (adjusted HR, 2.38, 95% CI 1.80-3.15, p<0.005) and was similar when the analysis was confined to patients without past uveitis. Uveitis was diagnosed more in females (2.1% vs 1.3%, HR 1.61, 95% CI 1.09-2.40, p<0.05), and was acute in all cases. Anterior uveitis was documented in 41.1% of the cases, 64.5% unilateral, and 9.3% bilateral. In the PsA group, using nested case control approach, only past uveitis [adjusted OR 136.4 (95% CI 27.38-679.88), p<0.005] and treatment with etanercept [adjusted OR 2.57 (95% CI 1.45-4.57), p=0.001] were independently associated with uveitis. Only one PsA patient with uveitis (out of 107) required systemic oral treatment with prednisone, while the rest of the patients were treated with topical glucocorticosteroids only. CONCLUSION PsA is associated with increased risk of uveitis. Past uveitis and treatment with etanercept were associated with higher risk of uveitis. Key Points • Psoriatic arthritis (PsA) is a major risk factor for uveitis with hazard ratio of 2.38 compared to healthy individuals without PsA. • Among PsA patients, the past event of uveitis and treatment with etanercept are risk factors for uveitis. • Uveitis in patients treated with biologics for their PsA requires topical therapy only in most of the cases.
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Affiliation(s)
- Nizar Hijazi
- Department of medicine A and Rheumatology Unit, Carmel Medical Center, Michal 7 St., 3436212, Haifa, Israel.
| | - Tal Gazitt
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
- Division of Rheumatology, University of Washington Medical Center, Seattle, USA
| | - Amir Haddad
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Muna Elias
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Sameer Kassem
- Department of medicine A, Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ilan Feldhamer
- Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel
| | - Arnon Dov Cohen
- Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shaul Sar
- Opthalmology department, Carmel Medical Center, Haifa, Israel
| | | | - Walid Saliba
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Devy Zisman
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Chen Y, Wang Y, Zhao X, Zhong H, Shi K, Huang X, Lin F, Xie M, Wang H, Sun X. A Bibliometric Analysis of Uveitis in the Past 20 Years. Ocul Immunol Inflamm 2024:1-10. [PMID: 38252121 DOI: 10.1080/09273948.2023.2295545] [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: 12/08/2022] [Accepted: 12/11/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE To assess the quantity and quality of global research on uveitis, visualize the research hotspots, and reveal the study trends in uveitis. METHODS This bibliometric analysis was performed with the data obtained from the Web of Science core collection (WoSCC) database and Scopus. Bibliometrix and VOSviewer were used to analyze and visualize study trends and hotspots. Citespace was used to conduct the cooperation and co-citation network analysis. RESULTS A total of 5837 and 7195 documents were exported for further analysis in WoSCC and Scopus, respectively. The USA has published the most articles related to uveitis (1627, 27.87%, WoS; 1979, 27.51%, Scopus) and accounted for the most frequency of total citations (42345 times total citations 35 900 times without self-citations in WoSCC database). Most of the papers focusing on uveitis were published in Ocular Immunology and Inflammation (761, 13.04% within WoS; 793, 11.02% within Scopus). Additionally, novel biotherapy is the hotspot of uveitis research which also may be a sustained research interest in the future. CONCLUSIONS An increasing trend of publications was found in uveitis research. The USA was the leading contributor in this field, and it was the center of cooperation network. Our study provided an overview of uveitis research, which may serve as a valuable reference and guide for stakeholders interested in uveitis.
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Affiliation(s)
- Yuhong Chen
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
| | - Yimin Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
| | - Xiaohuan Zhao
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
| | - Huimin Zhong
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
| | - Ke Shi
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
| | - Xiaoxu Huang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
| | - Feng Lin
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Minyue Xie
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hong Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
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Leal I, Steeples LR, Wong SW, Giuffrè C, Pockar S, Sharma V, Green EKY, Payne J, Jones NP, Chieng ASE, Ashworth J. Update on the systemic management of noninfectious uveitis in children and adolescents. Surv Ophthalmol 2024; 69:103-121. [PMID: 36682467 DOI: 10.1016/j.survophthal.2023.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/22/2022] [Accepted: 01/13/2023] [Indexed: 01/20/2023]
Abstract
Noninfectious uveitis (NIU) in children and adolescents is a rare but treatable cause of visual impairment in children. Treatments for pediatric NIU and their side effects, along with the risks of vision loss and the need for long-term disease monitoring, pose significant challenges for young patients and their families. Treatment includes local and systemic approaches and this review will focus on systemic therapies that encompass corticosteroids, conventional synthetic disease-modifying antirheumatic drugs (csDMARD), and biological disease-modifying antirheumatic drugs (bDMARD). Treatment is generally planned in a stepwise approach. Methotrexate is well-established as the preferential csDMARD in pediatric NIU. Adalimumab, an antitumor necrosis factor (TNF) agent, is the only bDMARD formally approved for pediatric NIU and has a good safety and efficacy profile. Biosimilars are gaining increasing visibility in the treatment of pediatric NIU. Other bDMARD with some evidence in literature for the treatment of pediatric NIU include infliximab, tocilizumab, abatacept, rituximab and, more recently, Janus kinase inhibitors. Important aspects of managing children on these systemic therapies include vaccination issues, risk of infection, and psychological distress. Also, strategies need to address regarding primary nonresponse/secondary loss of response to anti-TNF treatment, biological switching, and monitoring regimens for these drugs. Optimal management of pediatric uveitis involves a multidisciplinary team, including specialist pediatric uveitis and rheumatology nurses, pediatric rheumatologists, psychological support, orthoptic and optometry support, and play specialists.
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Affiliation(s)
- Inês Leal
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; Visual Sciences Study Centre, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| | - Laura R Steeples
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK; Academic Health Science Centre, Manchester, UK
| | - Shiao Wei Wong
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Chiara Giuffrè
- Centro Europeo di Oftalmologia, Palermo, Italy; Ophthalmology Department, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
| | - Sasa Pockar
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Vinod Sharma
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Elspeth K Y Green
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Janine Payne
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Nicholas P Jones
- School of Biological Sciences, University of Manchester, Manchester, UK
| | | | - Jane Ashworth
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK; Division of Evolution & Genomic Sciences, University of Manchester, Manchester, UK
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Kang TK, Le TT, Kwon H, Park G, Kim KA, Ko H, Hong S, Lee WB, Jung SH. Lithospermum erythrorhizon Siebold & Zucc. extract reduces the severity of endotoxin-induced uveitis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 121:155133. [PMID: 37812852 DOI: 10.1016/j.phymed.2023.155133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/21/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Uveitis is an inflammatory eye condition that threatens vision, and effective anti-inflammatory treatments with minimal side effects are necessary to treat uveitis. PURPOSE This study aimed to investigate the effects of Lithospermum erythrorhizon Siebold & Zucc. against endotoxin-induced uveitis in rat and mouse models. METHODS Endotoxin-induced uveitis models of rats and mice were used to evaluate the effects of l. erythrorhizon treatment. Clinical inflammation scores and retinal thickness were assessed in the extract of l. erythrorhizon-treated rats. Histopathological examination revealed inflammatory cell infiltration into the ciliary body. Protein concentration, cellular infiltration, and prostaglandin-E2 levels were measured in the aqueous humor of the extract of l. erythrorhizon-treated rats. Protective effects of l. erythrorhizon on the anterior segment of the eye were examined in mice with endotoxin-induced uveitis. Additionally, we investigated the effect of l. erythrorhizon on the expression of pro-inflammatory cytokines [tumor necrosis factor alpha, interleukin-6, and interleukin-8] in lipopolysaccharide-stimulated THP1 human macrophages and examined the involvement of nuclear factor kappaB/activator protein 1 and interferon regulatory factor signaling pathways. Furthermore, three components of l. erythrorhizon were identified and assessed for their inhibitory effects on LPS-induced inflammation in RAW264.7 macrophage cells. RESULTS Treatment of the extract of l. erythrorhizon significantly reduced clinical inflammation scores and retinal thickening in rats with endotoxin-induced uveitis. Histopathological examination revealed decreased inflammatory cell infiltration into the ciliary body. The extract of l. erythrorhizon effectively reduced the protein concentration, cellular infiltration, and PG-E2 levels in the aqueous humor of rats with endotoxin-induced uveitis. In mice with endotoxin-induced uveitis, the extract of l. erythrorhizon demonstrated a protective effect on the anterior segment of the eye by reducing inflammation and retinal thickening. The extract of l. erythrorhizon suppressed the expression of pro-inflammatory cytokines (tumor necrosis factor alpha, interleukin-6, and interleukin-8) in lipopolysaccharide-induced inflammation in THP1 human macrophages, by modulating nuclear factor kappaB/activator protein 1 and interferon regulatory factor signaling pathways. Moreover, shikonin, acetylshikonin, and β, β-dimethylacryloylshikonin showed dose-dependent inhibition of nitric oxide, tumor necrosis factor alpha and interleukin-6 production in RAW264.7 macrophage cells. CONCLUSION The extract of l. erythrorhizon is a potential therapeutic agent for uveitis management. Administration of the extract of l. erythrorhizon led to reduced inflammation, retinal thickening, and inflammatory cell infiltration in rat and mouse models of uveitis. The compounds (shikonin, acetylshikonin, and β, β-dimethylacryloylshikonin) identified in this study played crucial roles in mediating the anti-inflammatory effects of l. erythrorhizon. These findings indicate that the extract of l. erythrorhizon and its constituent compounds are promising candidates for further research and development of novel treatment modalities for uveitis.
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Affiliation(s)
- Tae Kyeom Kang
- Natural Product Research Center, Korea Institute of Science & Technology, Gangneung 25451, Republic of Korea
| | - Tam Thi Le
- Natural Product Research Center, Korea Institute of Science & Technology, Gangneung 25451, Republic of Korea; Division of Bio-Medical Science & Technology, KIST School, Korea University of Science and Technology, Gangneung 25451, Republic of Korea
| | - Hyukjoon Kwon
- Natural Product Research Center, Korea Institute of Science & Technology, Gangneung 25451, Republic of Korea
| | - Geon Park
- Natural Product Research Center, Korea Institute of Science & Technology, Gangneung 25451, Republic of Korea
| | - Kyung-A Kim
- Division of Medical Oncology, Department of Internal Medicine, Graduate School of Medical Science Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyejin Ko
- Natural Product Research Center, Korea Institute of Science & Technology, Gangneung 25451, Republic of Korea
| | - Suhee Hong
- Department of Aquatic Life Medicine, Gangneung-Wonju National University, Gangneung, 25457, Republic of Korea
| | - Wook-Bin Lee
- Natural Product Research Center, Korea Institute of Science & Technology, Gangneung 25451, Republic of Korea; Division of Bio-Medical Science & Technology, KIST School, Korea University of Science and Technology, Gangneung 25451, Republic of Korea.
| | - Sang Hoon Jung
- Natural Product Research Center, Korea Institute of Science & Technology, Gangneung 25451, Republic of Korea; Division of Bio-Medical Science & Technology, KIST School, Korea University of Science and Technology, Gangneung 25451, Republic of Korea.
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Burlo F, Tumminelli C, Pastore S, Stocco G, Curci D, Lucafò M, Tommasini A, Taddio A. Subcutaneous tocilizumab in the management of non-infectious uveitis in children: a brief report. Pediatr Rheumatol Online J 2023; 21:99. [PMID: 37700264 PMCID: PMC10496382 DOI: 10.1186/s12969-023-00883-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Tocilizumab is a humanized monoclonal antibody that acts as an IL-6 receptor antagonist. Intravenous tocilizumab is considered an option for children with anti-TNF refractory juvenile idiopathic arthritis-associated uveitis. In contrast, the potential of subcutaneous drug use with this indication is more controversial. Due to the decreased availability of intravenous tocilizumab during the COVID-19 pandemic, we started using the subcutaneous formulation of the drug in children with anti-TNF refractory uveitis. The study analyzes the serum concentration of tocilizumab and its clinical response in patients with anti-TNF refractory uveitis who started or switched to subcutaneous administration from intravenous use. METHODS Five patients with non-infectious uveitis were treated with subcutaneous tocilizumab. Ocular inflammation was evaluated on slit lamp examination during clinical control. Serum tocilizumab concentrations were determined by ELISA. RESULTS The mean blood concentration of tocilizumab was 61.4 µg/mL (range 2.7-137.0.), with higher values than levels recorded in adult patients with rheumatoid arthritis treated with intravenous tocilizumab. Three patients entered clinical remission. One patient developed a mild relapse and was treated with topical steroids. Only one patient did not respond to therapy. The medication was well tolerated without severe infection or other adverse events. CONCLUSION Our results support a possible role of subcutaneous tocilizumab in anti-TNF refractory uveitis.
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Affiliation(s)
- Francesca Burlo
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Cristina Tumminelli
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Serena Pastore
- Institute for Maternal and Child Health "IRCCS Burlo Garofolo", Trieste, Italy.
- Institute for Maternal and Child Health "IRCCS Burlo Garofolo", Trieste, Italy.
| | - Gabriele Stocco
- Institute for Maternal and Child Health "IRCCS Burlo Garofolo", Trieste, Italy
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Debora Curci
- Institute for Maternal and Child Health "IRCCS Burlo Garofolo", Trieste, Italy
| | - Marianna Lucafò
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Alberto Tommasini
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health "IRCCS Burlo Garofolo", Trieste, Italy
| | - Andrea Taddio
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health "IRCCS Burlo Garofolo", Trieste, Italy
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10
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Wu X, Tao M, Zhu L, Zhang T, Zhang M. Pathogenesis and current therapies for non-infectious uveitis. Clin Exp Med 2023; 23:1089-1106. [PMID: 36422739 PMCID: PMC10390404 DOI: 10.1007/s10238-022-00954-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Abstract
Non-infectious uveitis (NIU) is a disorder with various etiologies and is characterized by eye inflammation, mainly affecting people of working age. An accurate diagnosis of NIU is crucial for appropriate therapy. The aim of therapy is to improve vision, relieve ocular inflammation, prevent relapse, and avoid treatment side effects. At present, corticosteroids are the mainstay of topical or systemic therapy. However, repeated injections are required for the treatment of chronic NIU. Recently, new drug delivery systems that may ensure intraocular delivery of therapeutic drug levels have been highlighted. Furthermore, with the development of immunosuppressants and biologics, specific therapies can be selected based on the needs of each patient. Immunosuppressants used in the treatment of NIU include calcineurin inhibitors and antimetabolites. However, systemic immunosuppressive therapy itself is associated with adverse effects due to the inhibition of immune function. In patients with refractory NIU or those who cannot tolerate corticosteroids and immunosuppressors, biologics have emerged as alternative treatments. Thus, to improve the prognosis of patients with NIU, NIU should be managed with different drugs according to the response to treatment and possible side effects.
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Affiliation(s)
- Xue Wu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2000, Australia
| | - Mengying Tao
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ling Zhu
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2000, Australia
| | - Ting Zhang
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2000, Australia
| | - Ming Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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11
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Queiro R, Loredo M, Braña I, Pardo E, Alonso S, Alperi M. Managing psoriatic arthritis in different clinical scenarios. Expert Rev Clin Immunol 2023; 19:1469-1484. [PMID: 37589128 DOI: 10.1080/1744666x.2023.2249235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/14/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is a chronic, immune-mediated disease characterized by synovio-entheseal inflammation. It is estimated to affect around 30% of patients with psoriasis and significantly reduces patients' physical function and quality of life. There is a growing number of treatment options for PsA, but due to the heterogeneous clinical features of the disease and prevalence of comorbidities, managing PsA can be challenging. AREAS COVERED In this article, we review current understanding of the disease and available pharmacological options. Based on published treatment guidelines, emerging evidence and clinical experience, we provide our expert opinion on treatment strategies, taking into consideration the predominant disease domain and the presence of comorbidities, which can impact treatment decisions and clinical outcomes. EXPERT OPINION Biological and targeted synthetic disease-modifying agents are dramatically improving the lives of patients with PsA. Biosimilar TNF inhibitors offer a particularly versatile and cost-effective option, whilst newer biologics and targeted synthetic molecules that can be used to treat most domains of psoriatic disease are an attractive alternative to TNF inhibitors. Despite a lack of consensus on treatment sequencing and tapering, it is important that PsA patients, especially those with comorbidities, are looked after by a multidisciplinary team to optimize their care.
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Affiliation(s)
- Rubén Queiro
- Rheumatology & ISPA Translational Immunology Division, Central University Hospital of Asturias, Oviedo, Spain
- Department of Medicine, Oviedo University School of Medicine, Oviedo, Spain
| | - Marta Loredo
- Rheumatology Division, Central University Hospital of Asturias, Oviedo, Spain
| | - Ignacio Braña
- Rheumatology Division, Central University Hospital of Asturias, Oviedo, Spain
| | - Estefanía Pardo
- Rheumatology Division, Central University Hospital of Asturias, Oviedo, Spain
| | - Sara Alonso
- Rheumatology Division, Central University Hospital of Asturias, Oviedo, Spain
| | - Mercedes Alperi
- Rheumatology Division, Central University Hospital of Asturias, Oviedo, Spain
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12
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Tao T, Yang S, He D, Li Z, Chen B, Zhu L, Su W. Intravitreal dexamethasone implants facilitate the management of refractory Behçet's uveitis with vasculitis. Clin Immunol 2023; 251:109633. [PMID: 37150241 DOI: 10.1016/j.clim.2023.109633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/07/2023] [Accepted: 04/28/2023] [Indexed: 05/09/2023]
Abstract
To investigate the efficacy and safety of dexamethasone (DEX) implant, Ozurdex ®, as an adjunctive treatment for refractory Behçet's uveitis (BU), a total of 61 patients (80 eyes) were included in this cross-sectional study and divided into the non-DEX and DEX groups. After >12 months of treatment, the improvement in the fluorescein angiography score and vitritis score was significantly higher in the DEX group than in the non-DEX group. Although the posterior capsule opacification score was exacerbated, the rate of low-dose systemic glucocorticoid was higher and the relapse times were fewer in the DEX group. Therefore, Ozurdex® is an effective and safe option for patients with BU that are refractory to systemic immunosuppressant treatments by controlling vasculitis, stabilizing vitreous inflammation, preventing recurrence, and reducing daily glucocorticoid doses.
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Affiliation(s)
- Tianyu Tao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Shizhao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China; Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daquan He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Zhaohuai Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Binyao Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Lei Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Wenru Su
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China.
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Mase O, Qasem M, Beare N. Systematic review of studies comparing infliximab and adalimumab in autoimmune uveitis. BMJ Open Ophthalmol 2023; 8:e001303. [PMID: 37493653 PMCID: PMC10277136 DOI: 10.1136/bmjophth-2023-001303] [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: 03/28/2023] [Accepted: 05/30/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE This study aimed to review effectiveness studies comparing two biological anti-tumour necrosis factor agents, adalimumab (ADA) and infliximab (IFX), in the management of autoimmune uveitis. METHODS A systematic search was conducted across PubMed, Scopus, Web of Science and Google Scholar from 2014 until February 2022. The search included the following keywords "Adalimumab", "Infliximab", "Autoimmune", "Anterior", "Intermediate", "Posterior", "Panuveitis", "Refractory" and "Uveitis". Primary studies comparing both ADA and IFX in a population of autoimmune uveitis patients were considered. Outcomes of interest were measures of response to treatment and incidence of adverse events. RESULTS The preliminary literature search generated 7156 references. Six studies fulfilled the eligibility criteria and were included in the final analysis; all were non-randomised, retrospective or observational. The included studies found similar effectiveness and side effect profiles for both ADA and IFX in the management of autoimmune uveitis, however, one did not report effectiveness for each separately, and three were limited to Behcet's disease. CONCLUSION ADA and IFX seem to display comparable effectiveness and safety profiles. However, the available evidence remains scarce, of low quality and at high risk of bias. A direct comparison between ADA and IFX through large randomised controlled trials is needed to provide more substantial evidence of equivalence or superiority in uveitis.
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Affiliation(s)
- Oliver Mase
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Mustafa Qasem
- St Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Nicholas Beare
- St Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
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14
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Joubert M, Desbois AC, Domont F, Ghembaza A, Le Joncour A, Mirouse A, Maalouf G, Leclercq M, Touhami S, Cacoub P, Bodaghi B, Saadoun D. Behçet's Disease Uveitis. J Clin Med 2023; 12:jcm12113648. [PMID: 37297843 DOI: 10.3390/jcm12113648] [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: 03/12/2023] [Revised: 04/26/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
Uveitis in Behçet's disease (BD) is frequent (40% of cases) and is a major cause of morbidity. The age of onset of uveitis is between 20 and 30 years. Ocular involvement includes anterior, posterior, or panuveitis. Uveitis may be the first sign of the disease in 20% of cases or it may appear 2 or 3 years after the first symptoms. Panuveitis is the most common presentation and is more commonly found in men. Bilateralization usually occurs on average 2 years after the first symptoms. The estimated risk of blindness at 5 years is 10-15%. BD uveitis has several ophthalmological features that distinguish it from other uveitis. The main goals in the management of patients are the rapid resolution of intraocular inflammation, the prevention of recurrent attacks, the achievement of complete remission, and the preservation of vision. Biologic therapies have changed the management of intraocular inflammation. The aim of this review is to provide an update to a previous article by our team on pathogenesis, diagnostic approaches, and the therapeutic strategy of BD uveitis.
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Affiliation(s)
- Morgane Joubert
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose Inflammatoire, F-75013 Paris, France
| | - Anne-Claire Desbois
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose Inflammatoire, F-75013 Paris, France
| | - Fanny Domont
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose Inflammatoire, F-75013 Paris, France
| | - Amine Ghembaza
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose Inflammatoire, F-75013 Paris, France
| | - Alexandre Le Joncour
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose Inflammatoire, F-75013 Paris, France
| | - Adrien Mirouse
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose Inflammatoire, F-75013 Paris, France
| | - Georgina Maalouf
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose Inflammatoire, F-75013 Paris, France
| | | | - Sarah Touhami
- Department of Ophthalmology, Pitié-Salpêtrière University Hospital, Sorbonne Universités, F-75013 Paris, France
| | - Patrice Cacoub
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose Inflammatoire, F-75013 Paris, France
| | - Bahram Bodaghi
- Department of Ophthalmology, Pitié-Salpêtrière University Hospital, Sorbonne Universités, F-75013 Paris, France
| | - David Saadoun
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose Inflammatoire, F-75013 Paris, France
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Médical de Recherche (UMR)S 59, F-75013 Paris, France
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15
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Giorgiutti S, Jacquot R, El Jammal T, Bert A, Jamilloux Y, Kodjikian L, Sève P. Sarcoidosis-Related Uveitis: A Review. J Clin Med 2023; 12:jcm12093194. [PMID: 37176633 PMCID: PMC10178951 DOI: 10.3390/jcm12093194] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Sarcoidosis is an inflammatory disease that involves the eyes in 10-55% of cases, sometimes without systemic involvement. All eye structures can be affected, but uveitis is the most common ocular manifestation and causes vision loss. The typical ophthalmological appearance of these uveitis is granulomatous (in cases with anterior involvement), which are usually bilateral and with synechiae. Posterior involvement includes vitritis, vasculitis and choroidal lesions. Tuberculosis is a classic differential diagnosis to be wary of, especially in people who have spent time in endemic areas. The diagnosis is based on histology with the presence of non-caseating epithelioid granulomas. However, due to the technical difficulty and yield of biopsies, the diagnosis of ocular sarcoidosis is often based on clinico-radiological features. The international criteria for the diagnosis of ocular sarcoidosis have recently been revised. Corticosteroids remain the first-line treatment for sarcoidosis, but up to 30% of patients require high doses, justifying the use of corticosteroid-sparing treatments. In these cases, immunosuppressive treatments such as methotrexate may be introduced. More recent biotherapies such as anti-TNF are also very effective (as they are in other non-infectious uveitis etiologies).
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Affiliation(s)
- Stéphane Giorgiutti
- Department of Clinical Immunology and Internal Medicine, National Center for Systemic Autoimmune Diseases (CNR RESO), Strasbourg University Hospital, 67000 Strasbourg, France
- INSERM UMR-S1109, Université de Strasbourg, 67000 Strasbourg, France
| | - Robin Jacquot
- Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004 Lyon, France
- Faculté de Médecine et de Maïeutique Lyon-Sud-Charles Mérieux, Université de Lyon, 69000 Lyon, France
| | - Thomas El Jammal
- Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004 Lyon, France
- Faculté de Médecine et de Maïeutique Lyon-Sud-Charles Mérieux, Université de Lyon, 69000 Lyon, France
- Laboratory of Tissue Biology and Therapeutic Engineering, CNRS UMR5305, IBCP, University of Lyon, 69007 Lyon, France
| | - Arthur Bert
- Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004 Lyon, France
- Faculté de Médecine et de Maïeutique Lyon-Sud-Charles Mérieux, Université de Lyon, 69000 Lyon, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004 Lyon, France
- Faculté de Médecine et de Maïeutique Lyon-Sud-Charles Mérieux, Université de Lyon, 69000 Lyon, France
| | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004 Lyon, France
- UMR5510 MATEIS, CNRS, INSA Lyon, Université de Lyon 1, 69100 Villeurbanne, France
| | - Pascal Sève
- Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004 Lyon, France
- Faculté de Médecine et de Maïeutique Lyon-Sud-Charles Mérieux, Université de Lyon, 69000 Lyon, France
- Pôle IMER, Hospices Civils de Lyon, 69002 Lyon, France
- The Health Services and Performance Research (EA 7425 HESPER), Université de Lyon, 69003 Lyon, France
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Bitossi A, Mattioli I, Bettiol A, Palermo A, Malandrino D, Bacherini D, Virgili G, Giansanti F, Vannozzi L, Silvestri E. Non-anti TNFα biologic agents for non-infectious uveitis associated with systemic inflammatory diseases: a systematic review. Expert Rev Clin Immunol 2023; 19:549-560. [PMID: 36939549 DOI: 10.1080/1744666x.2023.2193687] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Non-infectious uveitis related to systemic inflammatory diseases represents a leading cause of blindness. Anti-TNFα agents are the first-line biologic therapy after traditional immunosuppressants, both for the control of ocular and systemic involvement. However, a subgroup of patients fails anti-TNFα agents, due to primary inefficacy, loss of efficacy or adverse events. AREAS COVERED This systematic review summarizes current evidence on the efficacy and safety of non-anti-TNFα biologics in adult patients with non-infectious uveitis associated with systemic inflammatory diseases. The systematic review of PubMed and Embase yielded 3663 records, from which 16 studies were included (13 non-controlled, 3 controlled trials). Most studies focused on Behçet's syndrome (BS) and juvenile idiopathic arthritis (JIA) and assessed the efficacy of tocilizumab (n=11), rituximab (n=3), secukinumab (n=1), or anakinra/canakinumab (n=1). A body of evidence supports the use of tocilizumab BS and JIA-associated uveitis, for improving visual acuity, reducing central macular thickness, inducing ocular remission, and sparing corticosteroids. Preliminary data suggest that rituximab may represent a valid alternative, particularly in JIA, while anakinra/canakinumab might play a role in BS-associated uveitis. Conversely, the role of secukinumab appears limited. EXPERT OPINION Current evidence encourages further investigations on the efficacy and safety of non-anti-TNFα agents in non-infectious non-idiopathic uveitis.
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Affiliation(s)
- Alice Bitossi
- Department of Surgery and Translational Medicine, Eye Clinic, University of Florence, Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Irene Mattioli
- Department of Experimental and Clinical Medicine, University of Firenze, Italy
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Firenze, Italy
| | - Adalgisa Palermo
- Department of Experimental and Clinical Medicine, University of Firenze, Italy
| | - Danilo Malandrino
- Department of Experimental and Clinical Medicine, University of Firenze, Italy
| | - Daniela Bacherini
- Department of Surgery and Translational Medicine, Eye Clinic, University of Florence, Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Gianni Virgili
- Department of Surgery and Translational Medicine, Eye Clinic, University of Florence, Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Fabrizio Giansanti
- Department of Surgery and Translational Medicine, Eye Clinic, University of Florence, Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Lorenzo Vannozzi
- Department of Surgery and Translational Medicine, Eye Clinic, University of Florence, Florence, Italy
| | - Elena Silvestri
- Department of Experimental and Clinical Medicine, University of Firenze, Italy
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Han H, Li S, Xu M, Zhong Y, Fan W, Xu J, Zhou T, Ji J, Ye J, Yao K. Polymer- and lipid-based nanocarriers for ocular drug delivery: Current status and future perspectives. Adv Drug Deliv Rev 2023; 196:114770. [PMID: 36894134 DOI: 10.1016/j.addr.2023.114770] [Citation(s) in RCA: 57] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/21/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
Ocular diseases seriously affect patients' vision and life quality, with a global morbidity of over 43 million blindness. However, efficient drug delivery to treat ocular diseases, particularly intraocular disorders, remains a huge challenge due to multiple ocular barriers that significantly affect the ultimate therapeutic efficacy of drugs. Recent advances in nanocarrier technology offer a promising opportunity to overcome these barriers by providing enhanced penetration, increased retention, improved solubility, reduced toxicity, prolonged release, and targeted delivery of the loaded drug to the eyes. This review primarily provides an overview of the progress and contemporary applications of nanocarriers, mainly polymer- and lipid-based nanocarriers, in treating various eye diseases, highlighting their value in achieving efficient ocular drug delivery. Additionally, the review covers the ocular barriers and administration routes, as well as the prospective future developments and challenges in the field of nanocarriers for treating ocular diseases.
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Affiliation(s)
- Haijie Han
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China; Zhejiang Provincial Key Lab of Ophthalmology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Su Li
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Mingyu Xu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Yueyang Zhong
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China; Zhejiang Provincial Key Lab of Ophthalmology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Wenjie Fan
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Jingwei Xu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China; Zhejiang Provincial Key Lab of Ophthalmology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Tinglian Zhou
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Jian Ji
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization of Ministry of Education, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Juan Ye
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China; Zhejiang Provincial Key Lab of Ophthalmology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China.
| | - Ke Yao
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China; Zhejiang Provincial Key Lab of Ophthalmology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China.
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18
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Busto-Iglesias M, Rodríguez-Martínez L, Rodríguez-Fernández CA, González-López J, González-Barcia M, de Domingo B, Rodríguez-Rodríguez L, Fernández-Ferreiro A, Mondelo-García C. Perspectives of Therapeutic Drug Monitoring of Biological Agents in Non-Infectious Uveitis Treatment: A Review. Pharmaceutics 2023; 15:pharmaceutics15030766. [PMID: 36986627 PMCID: PMC10051556 DOI: 10.3390/pharmaceutics15030766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
Biological drugs, especially those targeting anti-tumour necrosis factor α (TNFα) molecule, have revolutionized the treatment of patients with non-infectious uveitis (NIU), a sight-threatening condition characterized by ocular inflammation that can lead to severe vision threatening and blindness. Adalimumab (ADA) and infliximab (IFX), the most widely used anti-TNFα drugs, have led to greater clinical benefits, but a significant fraction of patients with NIU do not respond to these drugs. The therapeutic outcome is closely related to systemic drug levels, which are influenced by several factors such as immunogenicity, concomitant treatment with immunomodulators, and genetic factors. Therapeutic drug monitoring (TDM) of drug and anti-drug antibody (ADAbs) levels is emerging as a resource to optimise biologic therapy by personalising treatment to bring and maintain drug concentration within the therapeutic range, especially in those patients where a clinical response is less than expected. Furthermore, some studies have described different genetic polymorphisms that may act as predictors of response to treatment with anti-TNFα agents in immune-mediated diseases and could be useful in personalising biologic treatment selection. This review is a compilation of the published evidence in NIU and in other immune-mediated diseases that support the usefulness of TDM and pharmacogenetics as a tool to guide clinicians’ treatment decisions leading to better clinical outcomes. In addition, findings from preclinical and clinical studies, assessing the safety and efficacy of intravitreal administration of anti-TNFα agents in NIU are discussed.
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Affiliation(s)
- Manuel Busto-Iglesias
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain (C.M.-G.)
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
| | - Lorena Rodríguez-Martínez
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
| | - Carmen Antía Rodríguez-Fernández
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
- Ophthalmology Department, Bellvitge University Hospital, 08907 Barcelona, Spain
| | - Jaime González-López
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain (C.M.-G.)
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
| | - Miguel González-Barcia
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain (C.M.-G.)
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
| | - Begoña de Domingo
- Ophthalmology Department, University Clinical Hospital of Santiago Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Luis Rodríguez-Rodríguez
- Musculoskeletal Pathology Group, Hospital Clínico San Carlos, Instituto Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain
- Correspondence: (L.R.-R.); (A.F.-F.)
| | - Anxo Fernández-Ferreiro
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain (C.M.-G.)
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
- Correspondence: (L.R.-R.); (A.F.-F.)
| | - Cristina Mondelo-García
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain (C.M.-G.)
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
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Fang L, Liu J, Liu Z, Zhou H. Immune modulating nanoparticles for the treatment of ocular diseases. J Nanobiotechnology 2022; 20:496. [DOI: 10.1186/s12951-022-01658-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/03/2022] [Indexed: 11/25/2022] Open
Abstract
AbstractOcular diseases are increasingly influencing people’s quality of life. Complicated inflammatory mechanisms involved in the pathogenic process of ocular diseases make inflammation-targeting treatment a potential therapeutic approach. The limited efficacy of conventional anti-inflammatory therapeutic strategies, caused by various objective factors, such as complex ocular biological barriers, and subjective factors, such as poor compliance, are promoting the development of new therapeutic methods. With the advantages of considerable tissue permeability, a controllable drug release rate, and selective tissue targeting ability, nanoparticles have successfully captured researchers’ attention and have become a research hotspot in treating ocular diseases. This review will focus on the advantages of nanosystems over traditional therapy, the anti-inflammation mechanisms of nanoparticles, and the anti-inflammatory applications of nanoparticles in different ocular diseases (ocular surface diseases, vitreoretinopathy, uveal diseases, glaucoma, and visual pathway diseases). Furthermore, by analyzing the current situation of nanotherapy and the challenges encountered, we hope to inspire new ideas and incentives for designing nanoparticles more consistent with human physiological characteristics to make progress based on conventional treatments. Overall, some progress has been made in nanoparticles for the treatment of ocular diseases, and nanoparticles have rather broad future clinical translation prospects.
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Ayón C, Castán D, Mora A, Naranjo D, Obando F, Mora JJ. Monoclonal Antibodies: A Therapeutic Option for the Treatment of Ophthalmic Diseases of the Eye Posterior Segment. BORNEO JOURNAL OF PHARMACY 2022. [DOI: 10.33084/bjop.v5i3.2095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The eye is an organ that allows us to observe the outside world. Pathologies of the eye's posterior segment, such as glaucoma, macular degeneration, diabetic retinopathy, uveitis, and retinoblastoma, cause vision loss. Traditional treatments consist of applying topical medications that do not penetrate properly or using high doses that generate adverse effects. Different laser surgeries stop the pathology's progression but do not allow visual improvement. So, an alternative is to use monoclonal antibodies, proteins produced by different processes that selectively bind to metabolites associated with diseases, reducing the adverse effects of traditional treatments and improving the application of the drug in the area. The two main molecular targets are TNF (adalimumab, infliximab, and certolizumab pegol) and VEGF (bevacizumab and ranibizumab); other possibilities are under investigation.
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JAK-STAT Signaling Pathway in Non-Infectious Uveitis. Biochem Pharmacol 2022; 204:115236. [PMID: 36041544 DOI: 10.1016/j.bcp.2022.115236] [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: 07/20/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 11/22/2022]
Abstract
Non-infectious uveitis (NIU) refers to various intraocular inflammatory disorders responsible for severe visual loss. Cytokines participate in the regulation of ocular homeostasis and NIU pathological processes. Cytokine receptors transmit signals by activating Janus kinase (JAK) and signal transducer and activator of transcription (STAT) proteins. Increasing evidence from human NIU and experimental models reveals the involvement of the JAK-STAT signaling pathway in NIU pathogenesis. Several small-molecule drugs that potentially inhibit multiple cytokine-dependent pathways are under investigation for treating autoimmune diseases, implicating possible applications for NIU treatment. This review summarizes the current understanding of the diverse roles of the JAK-STAT signaling pathway in ocular homeostasis and NIU pathology, providing a rationale for targeting JAKs and STATs for NIU treatment. Moreover, available evidence for the safety and efficacy of JAK inhibitors for refractory uveitis and potential approaches for treatment optimization are discussed.
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Maalouf G, Andrillon A, Leclercq M, Sève P, Bielefeld P, Gueudry J, Sené T, Titah C, Moulinet T, Rouvière B, Sène D, Desbois AC, Domont F, Touhami S, Thibault T, Chamieh CE, Cacoub P, Kodjikian L, Biard L, Bodaghi B, Saadoun D. Lower Relapses Rate With Infliximab Versus Adalimumab in Sight-Threatening Uveitis: A Multicenter Study of 330 Patients. Am J Ophthalmol 2022; 238:173-180. [PMID: 35172172 DOI: 10.1016/j.ajo.2022.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/21/2022] [Accepted: 02/02/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To compare the relapse rate of sight-threatening noninfectious uveitis (NIU) in patients treated with infliximab (IFX) or adalimumab (ADA). DESIGN Observational retrospective multicenter study. METHODS A total of 330 patients (median age, 36 years; interquartile range, 27-54), 45.2% men) with sight-threatening NIU (ie, retinal vasculitis and/or macular edema) treated with anti-tumor necrosis factor [TNF]-α agents (IFX intravenously at 5 mg/kg at weeks 0, 2, 6, and every 4 to 6 weeks or ADA subcutaneously at 80 mg, then 40 mg every 2 weeks). Data were obtained retrospectively from patients' medical records. Main outcome measures were relapse rate, complete response of NIU, corticosteroid sparing effect, and safety. RESULTS Main etiologies of uveitis included Behçet disease (27%), idiopathic juvenile arthritis (5.8%), and sarcoidosis (5.5%). The estimated relapse rate at 6 months after introduction of biological agents was 13% (95% CI = 0.009-0.16). IFX was associated with less relapse risk than ADA (hazard ratio [HR] = 0.52, 95% CI = 0.36- 0.77, P = .001). ADA and IFX were comparable in terms of complete response rate of NIU as well as corticosteroid-sparing effect. Behçet disease was associated with higher odds of complete response (HR = 2.04, 95% CI = 1.16 -3.60, P = .01] and lower relapse rate (HR = 0.53, 95% CI = 0.33-0.85, P = .009) than other causes of NIU with anti-TNF-α agents. CONCLUSIONS In sight-threatening NIU, IFX seems to be associated with a lower relapse rate than ADA.
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Affiliation(s)
- Georgina Maalouf
- From the Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire; INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France
| | - Anaïs Andrillon
- Department of Biostatistics and Medical Information, CRESS UMR 1153, INSERM, ECSTRRA Team, Saint-Louis University Hospital, AP-HP, University of Paris, Paris, France
| | - Mathilde Leclercq
- From the Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire; INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France; Internal Medicine Department, CHU Rouen, Rouen, France
| | - Pascal Sève
- Internal Medicine Department, Hôpital de la Croix- Rousse, Hospices Civils de Lyon, Lyon Cedex, France; Faculté de Médecine Lyon-Sud, Université Claude Bernard-Lyon 1, Lyon, France
| | - Philip Bielefeld
- Internal Medicine and Systemic Diseases Department (Medicine Interne 2), Dijon University hospital, Dijon, France
| | - Julie Gueudry
- Ophthalmology Department, Hospital Charles Nicolle, CHU Rouen, Rouen, France; EA7510, UFR Santé, Rouen University, Rouen, France
| | - Thomas Sené
- Internal Medicine Department, Fondation Rothschild, Paris, France
| | - Cherif Titah
- Ophthalmology Department, Fondation Rothschild, Paris, France
| | - Thomas Moulinet
- Department of Internal Medicine, CHRU de Nancy, Nancy, France; Université de Lorraine, Inserm UMR_S 1116, Nancy, France
| | - Bénédicte Rouvière
- Internal Medicine and Pneumology Department, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France
| | - Damien Sène
- Internal Medicine Department, Lariboisière Hospital, Paris, France; INSERM UMR, Paris Diderot University, Paris, France
| | - Anne-Claire Desbois
- From the Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire; INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France
| | - Fanny Domont
- From the Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire; INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France
| | - Sara Touhami
- Ophthalmology Department, DHU View Restore, Pitié Salpêtrière Hospital, Paris, France
| | - Thomas Thibault
- From the Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire; INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France
| | - Carolla El Chamieh
- Department of Biostatistics and Medical Information, CRESS UMR 1153, INSERM, ECSTRRA Team, Saint-Louis University Hospital, AP-HP, University of Paris, Paris, France
| | - Patrice Cacoub
- From the Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire; INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France
| | - Laurent Kodjikian
- Ophthalmology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon Cedex, France; Faculté de Médecine Lyon-Sud, Université Claude Bernard-Lyon 1, Lyon, France
| | - Lucie Biard
- Department of Biostatistics and Medical Information, CRESS UMR 1153, INSERM, ECSTRRA Team, Saint-Louis University Hospital, AP-HP, University of Paris, Paris, France
| | - Bahram Bodaghi
- Ophthalmology Department, DHU View Restore, Pitié Salpêtrière Hospital, Paris, France
| | - David Saadoun
- From the Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire; INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France.
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Liu XB, Tang LS, Chen JW, Lin CS, Liu QH, Xu Q. Case Report: A Promising Treatment Strategy for Noninfectious Uveitis. Front Pharmacol 2022; 12:784860. [PMID: 35115933 PMCID: PMC8804343 DOI: 10.3389/fphar.2021.784860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Uveitis refers to inflammation in the uvea, retina, retinal blood vessels, and vitreous, which can lead to irreversible eye damage and permanent vision loss. Glucocorticoid drugs are the first-line treatment, but side effects, such as obesity and hyperglycemia, can occur. Therefore, biologics have become a new treatment choice. Case Presentation: A 18-year-old girl developed eye pain and was diagnosed with binocular uveitis. Prednisone 50 mg was administered once a day, and the redness and pain in both eyes improved. Later, the prednisone dose was gradually reduced, and treatment was discontinued 3 years ago. Two years ago, the patient’s condition relapsed, with both eyes becoming red and painful. She was administered prednisone 20 mg once daily and adalimumab. Visual acuity in both eyes continued to progressively decrease, accompanied by cataracts. At the same time, the patient experienced complications, including obesity and hyperglycemia. Subsequently, a new treatment regimen, oral prednisone 20 mg once a day, tofacitinib 5 mg twice a day, and methotrexate 10 mg once a week, as well as the use of insulin to control blood sugar, was initiated. One month later, the patient’s redness and eye pain eased, and her vision gradually improved. The dosage of prednisone was gradually reduced to 5 mg once daily. At the same time, her blood sugar returned to normal, and insulin was stopped. Outcomes: The patient was treated with tofacitinib for 10 months. Subsequently, her best-corrected visual acuity of the right eye rose from 0.06 to 0.075, and the best-corrected visual acuity of the left eye rose from CF/30 cm to CF/100 cm. Redness and eye pain were relieved, her glucocorticoid consumption reduced from 15 to 2.5 mg, and her blood sugar gradually normalized. Conclusion: This case study shows that tofacitinib relieves ocular inflammation in patients with uveitis and improves eyesight. We believe that JAK inhibitors could be another treatment option for noninfectious uveitis in patients who do not respond to conventional anti-TNF-α inhibitors (such as adalimumab).
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Affiliation(s)
- Xiao-Bao Liu
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lu-Shi Tang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Ophthalmology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jing-Wen Chen
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chang-Song Lin
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiu-Hong Liu
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Ophthalmology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Qiu-Hong Liu, ; Qiang Xu,
| | - Qiang Xu
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Qiu-Hong Liu, ; Qiang Xu,
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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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Girol AP, de Freitas Zanon C, Caruso ÍP, de Souza Costa S, Souza HR, Cornélio ML, Oliani SM. Annexin A1 Mimetic Peptide and Piperlongumine: Anti-Inflammatory Profiles in Endotoxin-Induced Uveitis. Cells 2021; 10:3170. [PMID: 34831393 PMCID: PMC8625584 DOI: 10.3390/cells10113170] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/23/2022] Open
Abstract
Uveitis is one of the main causes of blindness worldwide, and therapeutic alternatives are worthy of study. We investigated the effects of piperlongumine (PL) and/or annexin A1 (AnxA1) mimetic peptide Ac2-26 on endotoxin-induced uveitis (EIU). Rats were inoculated with lipopolysaccharide (LPS) and intraperitoneally treated with Ac2-26 (200 µg), PL (200 and 400 µg), or Ac2-26 + PL after 15 min. Then, 24 h after LPS inoculation, leukocytes in aqueous humor, mononuclear cells, AnxA1, formyl peptide receptor (fpr)1, fpr2, and cyclooxygenase (COX)-2 were evaluated in the ocular tissues, along with inflammatory mediators in the blood and macerated supernatant. Decreased leukocyte influx, levels of inflammatory mediators, and COX-2 expression confirmed the anti-inflammatory actions of the peptide and pointed to the protective effects of PL at higher dosage. However, when PL and Ac2-26 were administered in combination, the inflammatory potential was lost. AnxA1 expression was elevated among groups treated with PL or Ac2-26 + PL but reduced after treatment with Ac2-26. Fpr2 expression was increased only in untreated EIU and Ac2-26 groups. The interaction between Ac2-26 and PL negatively affected the anti-inflammatory action of Ac2-26 or PL. We emphasize that the anti-inflammatory effects of PL can be used as a therapeutic strategy to protect against uveitis.
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Affiliation(s)
- Ana Paula Girol
- Department of Physical and Morphological Sciences, University Center Padre Albino (UNIFIPA), Catanduva 15809-144, SP, Brazil; (A.P.G.); (S.d.S.C.); (H.R.S.)
- Department of Biology, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil;
- Post Graduate Program in Structural and Functional Biology, Escola Paulista de Medicina (UNIFESP-EPM), Federal University of São Paulo, São Paulo 04023-062, SP, Brazil
| | - Caroline de Freitas Zanon
- Department of Biology, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil;
| | - Ícaro Putinhon Caruso
- Department of Phisics, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil; (Í.P.C.); (M.L.C.)
| | - Sara de Souza Costa
- Department of Physical and Morphological Sciences, University Center Padre Albino (UNIFIPA), Catanduva 15809-144, SP, Brazil; (A.P.G.); (S.d.S.C.); (H.R.S.)
- Department of Biology, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil;
| | - Helena Ribeiro Souza
- Department of Physical and Morphological Sciences, University Center Padre Albino (UNIFIPA), Catanduva 15809-144, SP, Brazil; (A.P.G.); (S.d.S.C.); (H.R.S.)
- Department of Biology, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil;
| | - Marinônio Lopes Cornélio
- Department of Phisics, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil; (Í.P.C.); (M.L.C.)
| | - Sonia Maria Oliani
- Department of Biology, Institute of Biosciences, Humanities and Exact Sciences (Ibilce), São Paulo State University, (UNESP), São José do Rio Preto 15054-000, SP, Brazil;
- Post Graduate Program in Structural and Functional Biology, Escola Paulista de Medicina (UNIFESP-EPM), Federal University of São Paulo, São Paulo 04023-062, SP, Brazil
- Advanced Research Center in Medicine (CEPAM), União das Faculdades dos Grandes Lagos (Unilago), São José do Rio Preto 15030-070, SP, Brazil
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Harrison BM, Looney RJ, Williams ZR, DiLoreto DA. Steroid Allergy in a Patient With Behçet's Disease. Ophthalmic Surg Lasers Imaging Retina 2021; 52:447-449. [PMID: 34410184 DOI: 10.3928/23258160-20210727-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Immediate hypersensitivity reactions to systemic steroids are reported rarely in the literature. The authors present a case of Behçet's disease-associated panuveitis in a patient with skin test confirmed immunoglobulin E-mediated allergy to methylprednisolone and reported allergic reaction to prednisone. The patient tolerated prednisolone eyedrops for his anterior segment disease, as well as oral prednisolone for systemic therapy. This case demonstrates a challenge to conventional treatment, as it involves a hypersensitivity that is rarely reported. It also highlights class differences in corticosteroids with regard to immune reactivity. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:447-449.].
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Bernatchez PN, Tao B, Bradshaw RA, Eveleth D, Sessa WC. Characterization of a Novel Caveolin Modulator That Reduces Vascular Permeability and Ocular Inflammation. Transl Vis Sci Technol 2021; 10:21. [PMID: 34111267 PMCID: PMC8132009 DOI: 10.1167/tvst.10.6.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/30/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose Caveolin (Cav) regulates various aspect of endothelial cell signaling and cell-permeable peptides (CPPs) fused to domains of Cav can reduce retinal damage and inflammation in vivo. Thus, the goal of the present study was to identify a novel CPP that improves delivery of a truncated Cav modulator in vitro and in vivo. Methods Phage display technology was used to identify a small peptide (RRPPR) that was internalized into endothelial cells. Fusions of Cav with the peptide were compared to existing molecules in three distinct assays, vascular endothelial growth factor-A (VEGF) induced nitric oxide (NO) release, VEGF induced vascular leakage, and in a model of immune mediated uveitis. Results RRPPR was internalized efficiently and was potent in blocking NO release. Fusing RRPPR with a minimal Cav inhibitory domain (CVX51401) dose-dependently blocked NO release, VEGF induced permeability, and retinal damage in a model of uveitis. Conclusions CVX51401 is a novel Cav modulator that reduces VEGF and immune mediated inflammation. Translational Relevance CVX51401 is an optimized Cav modulator that reduces vascular permeability and ocular inflammation that is poised for clinical development.
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Affiliation(s)
- Pascal N. Bernatchez
- Vascular Biology and Therapeutics Program and Department of Pharmacology, Yale University School of Medicine, New Haven, CT, USA
| | - Bo Tao
- Vascular Biology and Therapeutics Program and Department of Pharmacology, Yale University School of Medicine, New Haven, CT, USA
| | | | | | - William C. Sessa
- Vascular Biology and Therapeutics Program and Department of Pharmacology, Yale University School of Medicine, New Haven, CT, USA
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Cunningham ET, Adán A, Nguyen QD, Zierhut M. Tocilizumab for the Treatment of Ocular Inflammatory Disease. Ocul Immunol Inflamm 2021; 29:2-5. [PMID: 33434090 DOI: 10.1080/09273948.2020.1859257] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Emmett T Cunningham
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA.,The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA.,The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California, USA
| | - Alfredo Adán
- The Department of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Quan Dong Nguyen
- The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tuebingen, Tuebingen, Germany
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