Corticosteroid-Sparing Strategies in the Treatment of Retinal Vasculitis in Systemic Lupus Erythematosus

Neumann, R; Foster, C S

doi:10.1097/00006982-199515030-00004

Cited by 17 publications

(5 citation statements)

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“…The most common side effects leading to drug discontinuation were leukopenia (18.1%) and cystitis/hematuria (7.7%). Various other studies have reported a higher incidence of the side effects in the range of 18 to 46% for leukopenia and 8 to 33% for hemorrhagic cystitis 25, 48-51. These differences in results probably derive from the fact that we only recorded problems resulting in discontinuation of therapy.…”

Section: Discussionmentioning

confidence: 64%

Cyclophosphamide for Ocular Inflammatory Diseases

et al. 2010

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Purpose-To evaluate the outcomes of cyclophosphamide therapy for non-infectious ocular inflammation. Design-Retrospective cohort studyParticipants-Two hundred fifteen patients with non-infectious ocular inflammation observed from initiation of cyclophosphamide.Methods-Patients initiating cyclophosphamide, without other immunosuppressive drugs (other than corticosteroids), were identified at four centers. Dose of cyclophosphamide, response to therapy, corticosteroid-sparing effects, frequency of discontinuation and reasons for discontinuation were obtained by medical record review of every visit.Main Outcome Measures-Control of inflammation, corticosteroid-sparing effects, discontinuation of therapy. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptOphthalmology. Author manuscript; available in PMC 2011 February 1. Published in final edited form as:Ophthalmology. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptResults-The 215 patients (381 involved eyes) meeting eligibility criteria carried diagnoses of uveitis (20.4%), scleritis (22.3%), ocular mucous membrane pemphigoid (45.6%) or other forms of ocular inflammation (11.6%). Overall, approximately 49.2% (95% confidence interval (CI): 41.7%-57.2%) gained sustained control of inflammation (for at least 28 days) within 6 months, and 76% (95% CI: 68.3%-83.7%) within 12 months. Corticosteroid-sparing success (sustained control of inflammation while tapering prednisone to 10 mg or less among those not meeting success criteria initially) was gained by 30.0% and 61.2% by six and 12 months respectively. Disease remission leading to discontinuation of cyclophosphamide occurred at the rate of 0.32/person-year (95% CI: 0.24 -0.41), and the estimated proportion with remission at or prior to 2 years was 63.1% (95% CI: 51.5%-74.8%). Cyclophosphamide was discontinued by 33.5% of patients within one year because of side effects-usually of a reversible nature.Conclusions-Our data suggest that cyclophosphamide is effective for the majority of patients for controlling inflammation and allowing tapering of systemic corticosteroids to 10 mg of prednisone or less, although a year of therapy may be needed to achieve these goals. Unlike with most other immunosuppressive drugs, disease remission was induced by treatment in the majority of patients who were able to tolerate therapy. In order to titrate therapy properly and to minimize the risk of serious potential side effects, a systematic program of laboratory monitoring is required. Judicious use of cyclophosphamide appears bene...

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Section: Discussionmentioning

confidence: 64%

Cyclophosphamide for Ocular Inflammatory Diseases

et al. 2010

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“…In a case series of retinal vasculitis, Neumann and Foster described seven patients treated with immunossupressive drugs (including methotrexate, azathioprine, cyclosporine, cyclophosphamide [cyc], and chlorambucil); this study suggests efficacy of steroid-sparing therapy, with final visual acuity >20/30 or improvement in all of them, although there was no control group and no uniformity in the indication of the drugs. 38 There are case reports supporting the use of cyc for induction therapy in retinal vasculitis. 4,13,27 Hickman et al.…”

Section: Clinical Manifestations and Diagnosismentioning

confidence: 99%

Neuro-ophthalmologic manifestations in systemic lupus erythematosus

Andrade

Balbi

Azevedo

et al. 2017

Lupus

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Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect different ocular structures, such as cornea, conjunctiva, episclera, sclera, uveal tract, retina, optic nerve and vessels. Neuro-ophthalmologic manifestations in SLE include different degrees of involvement of retina, choroid and optic nerve. Retinal changes are one of the most common ocular involvements and are frequently used as clinical criteria for activity, even if isolated. Studies show that up to 29% of patients with active SLE manifest retinal disease. The exact prevalence of choroidal disease is unknown, but is thought to be less common than retinopathy, due to under-diagnosis. Optic nerve disease, represented by optic neuritis and anterior/posterior ischaemic optic neuropathy, affects approximately 1% of SLE patients. These ocular manifestations have been associated with neurologic flares, antiphospholipid antibodies, nephropathy, and increased mortality. The aim of this paper is to review the different aspects of neuro-ophthalmologic involvement in SLE. Since these manifestations are frequent and potentially severe, a multi-professional team approach is needed to investigate properly and provide early aggressive treatment in order to avoid visual sequelae.

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“…Ab einer Gesamtdosis von 50 g ist das Risiko einer Spätneoplasie deutlich erhöht. Für die immunsuppressive Therapie des SLE kommen insbesondere Glukokortikoide, Azathioprin, Ciclosporin A, Mycophenolat-Mofetil, Cyclophosphamid oder Methotrexat in Kombination mit Chloroquin zur Anwendung [20,21]. Aufgrund der zahlreichen möglichen Nebenwirkungen systemischer immunsuppressiver Therapien ist eine engmaschige Kooperation mit dem Internisten nötig.…”

Section: Differenzialdiagnose Der Peripheren Ulzerativen Keratitisunclassified

Augenentzündungen bei entzündlichen Systemerkrankungen: Keratitis

Bachmann¹,

Jacobi²,

Cursiefen³

2011

Klin Monatsbl Augenheilkd

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Systemic inflammatory diseases are associated with keratitis. In addition to the much less frequently occurring non-ulcerative keratitis, ulcerative inflammation of the corneal periphery is common in systemic inflammatory diseases. Significant systemic inflammatory diseases in this context are autoimmune connective tissue diseases (including rheumatoid arthritis, systemic lupus erythematosus or primary vasculitides such as polyarteritis nodosa or Wegener's granulomatosis), systemic autoimmune dermatological disorders (such as the cicatrising pemphigoid or Stevens-Johnson syndrome) and autoimmune diseases of the lacrimal system (such as the lacrimal gland involvement in primary Sjogren's syndrome or in graft-versus-host disease). In severe cases of peripheral ulcerative keratitis intensive topical therapy is initially combined with a systemic high-dose steroid therapy. In further progressing ulceration, surgery may help to preserve or restore the integrity of the eye and may suppress the autoimmune response by shielding the corneal antigens from blood and the lymphatic system. Systemic immune modulating therapy has to be done in close consultation with the rheumatologist.

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Corticosteroid-Sparing Strategies in the Treatment of Retinal Vasculitis in Systemic Lupus Erythematosus

Cited by 17 publications

References 0 publications

Cyclophosphamide for Ocular Inflammatory Diseases

Cyclophosphamide for Ocular Inflammatory Diseases

Neuro-ophthalmologic manifestations in systemic lupus erythematosus

Augenentzündungen bei entzündlichen Systemerkrankungen: Keratitis

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