Inflammatory ocular adverse events with the use of oral bisphosphonates: a retrospective cohort study

Etminan, Mahyar; Forooghian, Farzin; Maberley, David

doi:10.1503/cmaj.111752

Cited by 65 publications

(45 citation statements)

References 19 publications

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“…Bisphosphonates are primarily used to treat osteoporosis [2]. They are generally well tolerated, even though several medications in this class have been associated with uveitis or other ocular side effects [3]. Bisphosphonates have a particularly strong ocular toxicity including cases of orbital inflammation, scleritis, and uveitis and AMD [4].…”

mentioning

confidence: 99%

Retinal epithelitis as ocular side effects of oral biphosphonates

Giudice¹,

Crepaldi²,

Catania³

et al. 2017

Clin Case Rep Rev

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Alendronate is a new bisphosphonate, primarily used for the treatment of osteoporosis and several other bone diseases. Herein we report a case of a patient showing an acute retinal pigment epithelitis (ARPE) following oral administration of alendronate due to osteoprosis. A 50-year old female referred to our observation complaining visual blurring and metamorphopsia in her left eye. She did not report ocular impairment in the past. Her clinical history was unremarkable for any systemic disease except she had being suffering for osteoporis for 6 months treated by means administration of oral alendronate. Her visual acuity was 20/40 OS and 20/20 OD respectively. There was no vitritis or anterior uveitis. At fundus examination subtle clumps of hyperpigmentation surrounded by a paler halo of hypopigmentation around macula of the retinal pigment epithelium (RPE) were shown in OS. In the right eye ophthalmoscopy showed some cluster of irregular pigmentation above the fovea associated with slight hypopigmentation surrounding the clump. Fluorescein angiography (FA) revealed an irregular patchy area of early hypofluorescence, surrounded by hyperfluorescence, while fading in the late phase ( Figure 1A). Earlyphase and midphase indocyanine green angiography (ICG) showed a patchy macular hypofluorescence in both eyes (Figures 1B and 1C). Similar disseminated spots of hypofluorescence were shown at the periphery nasally to the optic disk; hypofluorescent halo with a petaloid like appearance of the macular area was observed in OS on late ICG. Patient discontinued treatment with alendronate. She underwent weekly ocular examination up to 4 weeks. Her symptoms improved in OS with VA of 20/20 in 1 week after discontinuation. FA and ICG revealed some patched areas of irregular hypofluorescence surrounding the old spots due to filling defect of choroidal vessels and characterized by late staining of dye on FA and no leakage (Figures 2A and 2B). Hypofluorescent areas were shown on both intermediate and late ICG phases with reducing size compared to the acute phases in the same areas.Acute retinal pigment epithelitis (ARPE), also known as Krill's disease, is characterized by an acute and severe loss of vision in young, healthy adults with a self-limiting course and affecting both males and females equally [1]. It is thought to represent areas of RPE inflammation with breakdown of the pigment epithelial barrier and subsequent leakage of serous fluid. We report a case of a patient in which ARPE occurred after a long term administration of oral alendronate. These side effects are solved with discontinuation of therapy. A number of medications encompassing various forms of administration, including topical formulations, periocular and intraocular injections, and systemic medications, have been associated with uveitis. Bisphosphonates are primarily used to treat osteoporosis [2]. They are generally well tolerated, even though several medications in this class have been associated with uveitis or other ocular side effects [3]. Bisphosphona...

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mentioning

confidence: 99%

Retinal epithelitis as ocular side effects of oral biphosphonates

Giudice¹,

Crepaldi²,

Catania³

et al. 2017

Clin Case Rep Rev

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“…Numerous general population-based studies have been successfully conducted using these databases. [23][24][25][26] Population-based cohorts From the administrative data files, we assembled a population-based cohort of all BC adults with SARDs during the years 1996-2010. SARDs cases were identified on the basis of International Classification of Diseases Ninth (ICD-9) and Tenth (ICD-10) Revision diagnostic codes (see online supplementary file) recorded for outpatient encounters and hospitalisations, having either: (A) ≥2 ICD-9 codes for SARDs ≥2 months apart but within a 2-year period by a non-rheumatologist physician; or (B) one ICD-9 or ICD-10 code for SARDs by a rheumatologist (at any time) or from hospitalisation.…”

Section: Data Sourcementioning

confidence: 99%

Filling the gaps in SARDs research: collection and linkage of administrative health data and self-reported survey data for a general population-based cohort of individuals with and without diagnoses of systemic autoimmune rheumatic disease (SARDs) from British Columbia, Canada

et al. 2017

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PurposeSystemic autoimmune rheumatic diseases (SARDs) are a group of debilitating autoimmune diseases, including systemic lupus erythematosus and related disorders. Assessing the healthcare and economic burden of SARDs has been challenging: while administrative databases can be used to determine healthcare utilisation and costs with minimal selection and recall bias, other health, sociodemographic and economic data have typically been sourced from highly selected, clinic-based cohorts. To address these gaps, we are collecting self-reported survey data from a general population-based cohort of individuals with and without SARDs and linking it to their longitudinal administrative health data.ParticipantsUsing administrative data from the province of British Columbia (BC), Canada, we established a population-based cohort of all BC adults receiving care for SARDs during 1996–2010 (n=20 729) and non-SARD individuals randomly selected from the general population. BC Ministry of Health granted us contact information for 12 000 SARD and non-SARD individuals, who were recruited to complete the surveys by mail or online.Findings to dateFour hundred individuals were initially invited to participate, with 135 (34%) consenting and 127 (94%) submitting the first survey (72% completed online). Sixty-three (49.6%) reported ≥1 SARD diagnosis. The non-SARDs group (n=64) was 92% female with mean age 57.0±11.6 years. The SARDs group (n=63) was 94% female with mean age 56.5±13.1 years. Forty-eight per cent of those with SARDs were current-or-former smokers (mean 10.6±16.2 pack-years), and 33% were overweight or obese (mean body mass index of 24.4±5.3).Future plansHealth and productivity data collected from the surveys will be linked to participants’ administrative health data from the years 1990–2013, allowing us to determine the healthcare and lost productivity costs of SARDs, and assess the impact of patient-reported variables on utilisation, costs, disability and clinical outcomes. Findings will be disseminated through scientific conferences and peer-reviewed journals.

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“…In patients with known joint disease, it is important to recognize that ocular inflammation may be related, not to the disease itself, but to an infection developed as a result of immunodepression (e.g., tuberculosis or toxoplasmosis) [26]. Furthermore, bisphosphonates, particularly those containing nitrogen, can induce unilateral or bilateral acute anterior uveitis (0.8% of patients with zoledronic acid and 0.29% with oral bisphosphonates) [27,28]. In contrast to uveitis associated with TNF␣ antagonist therapy, bisphosphonate-induced uveitis develops within a few days after treatment initiation and resolves rapidly after discontinuation of the offending agent or with topical treatment.…”

Section: Uveitis and Inflammatory Joint Diseasementioning

confidence: 99%