Are patients with inflammatory eye disease treated with systemic immunosuppressive therapy at increased risk of malignancy?

Yates, William B.; McCluskey, Peter; Wakefield, Denis

doi:10.1186/1869-5760-3-48

Cited by 6 publications

(3 citation statements)

References 60 publications

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“…The first is a potentially higher risk of malignancies in AU patients receiving systemic immunosuppressive therapy [104]. Nonetheless, given that the clinical advantages largely outweigh the risks, immunosuppressive therapy should be administered whenever it is deemed beneficial, and the potential risk for the later occurrence of a tumor should not be a hindrance to its use.…”

Section: Treatment Of Autoimmune Uveitismentioning

confidence: 98%

Autoimmune uveitis: clinical, pathogenetic, and therapeutic features

et al. 2015

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Autoimmune uveitis (AU), an inflammatory non-infectious process of the vascular layer of the eye, can lead to visual impairment and, in the absence of a timely diagnosis and suitable therapy, can even result in total blindness. The majority of AU cases are idiopathic, whereas fewer than 20 % are associated with systemic diseases. The clinical severity of AU depends on whether the anterior, intermediate, or posterior part of the uvea is involved and may range from almost asymptomatic to rapidly sight-threatening forms. Race, genetic background, and environmental factors can also influence the clinical picture. The pathogenetic mechanism of AU is still poorly defined, given its remarkable heterogeneity and the many discrepancies between experimental and human uveitis. Even so, the onset of AU is thought to be related to an aberrant T cell-mediated immune response, triggered by inflammation and directed against retinal or cross-reactive antigens. B cells may also play a role in uveal antigen presentation and in the subsequent activation of T cells. The management of AU remains a challenge for clinicians, especially because of the paucity of randomized clinical trials that have systematically evaluated the effectiveness of different drugs. In addition to topical treatment, several different therapeutic options are available, although a standardized regimen is thus far lacking. Current guidelines recommend corticosteroids as the first-line therapy for patients with active AU. Immunosuppressive drugs may be subsequently required to treat steroid-resistant AU and for steroid-sparing purposes. The recent introduction of biological agents, such as those targeting tumor necrosis factor-α, is expected to remarkably increase the percentages of responders and to prevent irreversible sight impairment. This paper reviews the clinical features of AU and its crucial pathogenetic targets in relation to the current therapeutic perspectives. Also, the largest clinical trials conducted in the last 12 years for the treatment of AU are summarized and critically discussed.

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Section: Treatment Of Autoimmune Uveitismentioning

confidence: 98%

Autoimmune uveitis: clinical, pathogenetic, and therapeutic features

et al. 2015

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“…Liaison with other specialists such as physicians and dermatologists, when required, facilitates the management of any potential malignancies and optimize patient outcomes. 21 This study must be replicated in a large, long-term, prospective cohort to determine the relative risk of different treatment regimens, and the specific type and severity of IED. Such a study would have the statistical power to stratify by systemic involvement and address the issue of whether the type of immunosuppressive agent, and the duration and intensity of immunosuppression, increases the risk of malignancy in patients with IED.…”

Section: Discussionmentioning

confidence: 99%

Malignancy Risk in Patients with Inflammatory Eye Disease Treated with Systemic Immunosuppressive Therapy

Yates¹,

Vajdic²,

Na³

et al. 2015

Ophthalmology

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“…109 Additionally, a recent review by Yates et al assessed whether inflammatory eye disease treated with immunosuppression conferred an increased risk of malignancy and found significant increase in malignancies, particularly with non-melanocyte skin cancers and lymphomas. 167 Even though evidence for this risk has not been comprehensively assessed, preventative strategies should be considered in scleritis and episcleritis patients treated with immunosuppressive therapy.…”

Section: Ocular Complications and Surgical Managementmentioning

confidence: 99%