Efficacy and safety of immunomodulatory drugs in patients with anterior uveitis

Abstract

Background:To assess the efficacy and safety of immunomodulatory drugs in patients with noninfectious anterior uveitis (AU).Methods:Systematic review of studies were retrieved from Medline (1961 to March 2016), Embase (1961 to March 2016), and Cochrane Library (up to March 2016), and a complementary hand search was also performed. The selection criteria were as follows: (population) noninfectious AU patients, adults; (intervention) immunomodulatory drugs (any dose, regimen, route of administration, duration of treatment); (outcome) control of inflammation, steroid-sparing effect, AU flares, adverse events, and so on; (study design) systematic literature reviews, randomized controlled trials, and observational studies. The study quality was assessed using the Jadad scale and according to The Oxford Centre for Evidence-based Medicine (update 2009).Results:We included 13 studies of moderate-poor quality, with a mean duration from 5 months to 20 years, and number of AU patients ranging from 9 to 274. Patient's demographic and clinical characteristics were very heterogeneous. In most cases, uveitis anatomic classification criteria and outcomes definitions were unclear. Some of the studies only included AU patients with a systemic disease associated, mostly spondyloarthritis, others, mixed populations (idiopathic and systemic disease associated patients), and in some articles this data is not described. We found that methotrexate, cyclosporine A, azathioprine, adalimumab, and golimumab might prevent AU flares, improve ocular inflammation and visual acuity, and decrease systemic steroids doses.Conclusions:Although there is a lack of robust evidence, methotrexate, cyclosporine A, azathioprine, adalimumab, and golimumab might be effective in AU patients.

Intra-ocular dendritic cells are increased in HLA-B27 associated acute anterior uveitis

“…We find T-cells more activated in B27-AU than in B27+AAU. Indeed, SpA associated uveitis does not respond properly to T-cell inhibition 11 . Also, SpA patients (with or without AAU) mostly do not benefit from treatment with the anti-CD20 antibody rituximab 57 .…”

“…B27+AAU is thus regarded as a prototypic ocular autoimmune disease and, accordingly, its treatment is based on corticosteroids 6,7 and classical and biological disease modifying anti-rheumatic drugs 8,9 . Notably, although T- cellinhibition (e.g., by cyclosporine A) is beneficial 10 , it provides limited efficacy in B27+AAU 11 , suggesting a yet poorly defined role of innate immune cells in its pathogenesis.…”

Management of particular clinical situations in psoriatic arthritis: an expert’s recommendation document based on systematic literature review and extended Delphi process

“…Finally, for patients with PsA and uveitis, csDMARDs or TNF inhibitors (except etanercept) might be preferred [ 124 , 125 ].…”

The Management of Acute Anterior Uveitis Complicating Spondyloarthritis: Present and Future

“…The addition of methotrexate produced the resolution of noninfectious uveitis, despite corticosteroid withdrawal, in about 60% of patients within one year [ 55 ]. Furthermore, it decreases the frequency of AAU flares during the progressive tapering of systemic corticosteroids treatment [ 56 ]. Data on sulfasalazine for the treatment of AAU are very limited, with a single paper reporting a significant reduction in the number of AAU flares and improvement in visual acuity in SpA [ 56 ].…”

“…Furthermore, it decreases the frequency of AAU flares during the progressive tapering of systemic corticosteroids treatment [ 56 ]. Data on sulfasalazine for the treatment of AAU are very limited, with a single paper reporting a significant reduction in the number of AAU flares and improvement in visual acuity in SpA [ 56 ]. Similarly, leflunomide had only few anecdotal data regarding the treatment of uveitis [ 57 ].…”