Clinical Outcomes of Cyclosporine Treatment for Noninfectious Uveitis

Lee, Sun-Ho; Chung, Hum; Yu, Hyeong Gon

doi:10.3341/kjo.2012.26.1.21

Cited by 13 publications

(4 citation statements)

References 22 publications

(22 reference statements)

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“…These data appear to be in contrast to reports by several other authors treating pediatric PP, PU, and VKH with various formulations of steroids and a variety of DMARDs (16,(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44). Expectedly, these studies reported significant degrees of steroid toxicity, including relatively high rates of cataract formation, subretinal neovascularization, and glaucoma requiring cryotherapy, laser photocoagulation, or surgical management (33)(34)(35)(36).…”

Section: Reiff 1594 |contrasting

confidence: 80%

“…In addition, even though rather mixed results were observed in several studies of DMARDs in patients with PP, PU, and VKH, the results appeared to be better overall when compared to our reported outcomes (39–45). In our study population, MTX was the most commonly used DMARD, prescribed in an average of 92% of patients, followed by MMF in 7.5% of patients, and CSA, which was used in only 1 patient.…”

Section: Discussioncontrasting

confidence: 56%

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Clinical Presentation, Management, and Long‐Term Outcome of Pars Planitis, Panuveitis, and Vogt‐Koyanagi‐Harada Disease in Children and Adolescents

Reiff

2020

Arthritis Care & Research

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Objective. Chronic uveitis is a common manifestation of pediatric rheumatologic conditions and may result in irreversible blindness and long-term disability. While chronic anterior uveitis is the most commonly encountered ocular manifestation of rheumatic disease, little is known about the clinical presentation, management, and long-term outcome of more complex eye conditions such as pars planitis (PP), panuveitis (PU), and Vogt-Koyanagi-Harada disease (VKH). The present study was undertaken to comprehensively assess the long-term safety and efficacy of disease-modifying antirheumatic drugs (DMARDs) and biologics for the treatment of pediatric and adolescent patients with PP, PU, and VKH. Methods. We retrospectively reviewed a cohort of 75 children and adolescents with idiopathic PP (n = 50), PU (n = 11), and VKH (n = 14) followed by the Pediatric Rheumatology Core at Children's Hospital Los Angeles and evaluated referral patterns, clinical presentation, treatment response, and long-term clinical outcome. Results. Patients were followed for an average of 52 months. The mean age at disease onset was 10 years. Bilateral eye involvement was seen in 87% of the patients. At first presentation to an ophthalmologist, glaucoma was noted in 21%, and vision loss (<20/40) in 87% of patients, while legal blindness (≤20/200 in the better-seeing eye) was diagnosed in 18 of 75 (24%) patients (PP 22%, PU 36%, and VKH 21%). The average referral time to a pediatric rheumatologist was 13 months (range 1-96 months). Topical steroids were used in all patients, but 98% of patients required additional DMARDs, and 73% required therapy with biologics. After a mean of 52 months, 35% of patients across all disease groups had significant vision loss or were blind, and only 28% were in clinical remission without medications. The worst outcome was observed in children with PU. Application of regression analysis demonstrated that young age at onset, delayed referral to a pediatric rheumatologist, and chronic disease were strong predictors for the risk of long-term blindness. Conclusion. PP, PU, and VKH involve a high risk of permanent vision loss and should be managed by a skilled rheumatologist as early and as aggressively as possible.

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Section: Reiff 1594 |contrasting

confidence: 80%

Section: Discussioncontrasting

confidence: 56%

Clinical Presentation, Management, and Long‐Term Outcome of Pars Planitis, Panuveitis, and Vogt‐Koyanagi‐Harada Disease in Children and Adolescents

Reiff

2020

Arthritis Care & Research

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“…The immunosuppressive effects of cyclosporine occur through reversible inhibition of calcineurin and the prevention of inflammatory function of T cells in the peripheral circulation [ 94 ]. In 1983, cyclosporine was first used for therapy of uveitis by Nussenblatt et al In addition, different research groups have investigated the effects of cyclosporine on serpiginous choroiditis, Behcet’s disease-associated uveitis, VKH disease, birdshot retinochoroiditis and idiopathic uveitis [ 95 ]. In the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) study, cyclosporine monotherapy achieved 33.4% inflammation control at 6 months and 51.9% at 12 months among 373 patients with non-infectious ocular inflammation [ 96 ].…”

Section: Pathogenesis and Experimental Models Of Niumentioning

confidence: 99%

Pathogenesis and current therapies for non-infectious uveitis

Tao

Zhu

et al. 2022

Clin Exp Med

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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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“…[220] As a treatment for patients with uveitis, cyclosporine is effective in controlling inflammation, and its effects are sustained even after the reduction of corticosteroid dosage. [131,221] For example, a retrospective cohort study on 373 patients demonstrated clinically acceptable control over inflammation at 6 months and 1 year for 33.4% and 51.9% of patients, respectively. [222] Despite the efficacy in managing the inflammation, cyclosporine can lead to severe nephrotoxicity, [223,224] and in addition, some patients can be refractory to treatment.…”

Section: Ocular Diseasesmentioning

confidence: 99%

Modern Therapeutic Approaches for Noninfectious Ocular Diseases Involving Inflammation

Ratay

Bellotti

Gottardi³

et al. 2017

Adv Healthcare Materials

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Dry eye disease (DED), age-related macular degeneration (AMD), and Uveitis are ocular diseases that significantly affect the quality of life of millions of people each year. In these diseases, the action of chemokines, pro-inflammatory cytokines, and immune cells drives a local inflammatory response that results in ocular tissue damage. Multiple therapeutic strategies have been developed to either address the symptoms or abate the underlying cause of these diseases. Herein, we will review the challenges to deliver drugs to the relevant location in the eye for each of these diseases as well as current and innovative therapeutic approaches that attempt to restore homeostasis within the ocular microenvironment.

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Clinical Outcomes of Cyclosporine Treatment for Noninfectious Uveitis

Cited by 13 publications

References 22 publications

Clinical Presentation, Management, and Long‐Term Outcome of Pars Planitis, Panuveitis, and Vogt‐Koyanagi‐Harada Disease in Children and Adolescents

Clinical Presentation, Management, and Long‐Term Outcome of Pars Planitis, Panuveitis, and Vogt‐Koyanagi‐Harada Disease in Children and Adolescents

Pathogenesis and current therapies for non-infectious uveitis

Modern Therapeutic Approaches for Noninfectious Ocular Diseases Involving Inflammation

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