Noninfectious uveitis: strategies to optimize treatment compliance and adherence

Dolz-Marco, Rosa; Gallego-Pinazo, Roberto; Díaz-Llopis, M.; Cunningham, Emmett T.; Arévalo, J. Fernando

doi:10.2147/opth.s36650

Cited by 7 publications

(7 citation statements)

References 34 publications

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“…35 Or perhaps patients perceive this route of administration to be not as important as systemic therapy? One can monitor adherence in patients taking systemic therapy for inflammatory eye disease by measuring plasma drug levels, medication counting and optimizing administration, such as the use of intravenous drugs, 18 but these are not appropriate for patients on topical medication.…”

Section: Discussionmentioning

confidence: 99%

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Adherence to Topical Medication in Patients with Inflammatory Eye Disease

Javidi

Poonit

Patel

et al. 2020

Ocular Immunology and Inflammation

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Where a licence is displayed above, please note the terms and conditions of the licence govern your use of this document.When citing, please reference the published version. Take down policyWhile the University of Birmingham exercises care and attention in making items available there are rare occasions when an item has been uploaded in error or has been deemed to be commercially or otherwise sensitive.

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Section: Discussionmentioning

confidence: 99%

“…[11][12][13][14][15][16][17] In the ophthalmic literature there is very little information on adherence in inflammatory eye disease. 18 We wished to evaluate adherence to topical medication in patients with inflammatory eye disease in a tertiary Eye Centre setting and to identify factors that may influence this.…”

Section: Introductionmentioning

confidence: 99%

Adherence to Topical Medication in Patients with Inflammatory Eye Disease

Javidi

Poonit

Patel

et al. 2020

Ocular Immunology and Inflammation

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“…For example, in the adult glaucoma literature, simplified dosing regimens and/or decreased frequency of dosing has been shown to improve reports of adherence [54, 55]. Likewise, recommendations have been proposed to increase adherence in the adult population with uveitis [28]. However, risk factors and interventions for incomplete treatment adherence have not been rigorously studied in children with uveitis.…”

Section: Discussionmentioning

confidence: 99%

“…To successfully manage and to treat uveitis, frequent appointments and complicated medication regimens are often needed. Adherence to both treatment and follow-up evaluations are paramount to treatment success of uveitis [27, 28]. Children represent a vulnerable population, and treatment success may largely depend on the partnership between the caregivers and the clinicians to promote adherence.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of long-term infliximab use and impact of treatment adherence on disease control in refractory, non-infectious pediatric uveitis

et al. 2019

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BackgroundRefractory non-infectious uveitis is a serious condition that leads to ocular complications and vision loss and requires effective systemic treatment to control disease. The effectiveness of long-term infliximab [IFX] in refractory non-infectious childhood uveitis and the impact of treatment adherence on disease control were evaluated.MethodsRetrospective, single-center study between December 2002 and April 2016 of 27 children with refractory non-infectious uveitis [17 with juvenile idiopathic arthritis, JIA] treated with long-term IFX [9+ months]. Disease activity was assessed prior to and while on IFX using the Standardization of Uveitis Nomenclature [SUN]. Number of visits per year with active uveitis was analyzed by repeated measures logistic regression analysis from 2 years prior to IFX initiation or from onset of uveitis until most recent visit on IFX. Incomplete treatment adherence was assessed for each visit and defined as any deviance in corticosteroid use, prescribed infusion frequency, and/or follow-up examination frequency.ResultsPrimary outcomes were sustained uveitic and systemic disease control prior to and during IFX treatment and the impact of incomplete adherence on uveitic disease control while on IFX. Secondary outcomes included corticosteroid and glaucoma medication requirement, ocular complications and need for surgical intervention. Mean age at IFX initiation was 10.4 ± 4.5 years; initial mean dose was 6.6 ± 2.2 mg/kg [and given at weeks 0, 2, 4 and q4 weeks thereafter for 93%]. Median duration on IFX was 35 [range 9–128] months. Prior to IFX, 14/27 patients had failed adalimumab ± methotrexate [MTX]; 21/27 failed MTX. IFX led to uveitis control in 89% and arthritis control in 76% (13/17). The odds ratio of having controlled disease after IFX was 4.1 (2.6, 6.4) compared to pre-treatment visits. Topical corticosteroids and glaucoma medications were statistically decreased (p = 0.007 right eye [OD], 0.003 left eye [OS] and p = 0.001 OD, p = 0.028 OS respectively). Incomplete adherence to treatment showed 10.3 times greater odds (7.1, 15.0) of having disease activity than full adherence.ConclusionsThis study adds significantly to the IFX literature by documenting outstanding uveitis control with long-term IFX treatment in non-infectious pediatric uveitis patients. Higher dosage and shorter interval were utilized without adverse effects. Importantly, this is the first study, to our knowledge, to document the significant impact of treatment adherence on uveitis control.

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“…SUN defines recurrent uveitis as the condition in which the episodes are separated by at least three months of inactivity without treatment. On the contrary, any uveitis under steroid or immunosuppressive/immunomodulatory therapy remains active, and its socio-economic burden is high [ 3 , 6 , 7 , 8 ]. In this context, molecular information about recurrent non-infectious acute uveitis (NIAU) in the silent stage of the disease has not yet been reliably determined.…”

Section: Introductionmentioning

confidence: 99%

Signature of Circulating Biomarkers in Recurrent Non-Infectious Anterior Uveitis. Immunomodulatory Effects of DHA-Triglyceride. A Pilot Study

et al. 2021

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The purpose of this study was to identify circulating biomarkers of recurrent non-infectious anterior uveitis (NIAU), and to address the anti-inflammatory effects of triglyceride containing docosahexaenoic acid (DHA-TG). A prospective multicenter study was conducted in 72 participants distributed into: patients diagnosed with recurrent NIAU in the quiescence stage (uveitis group (UG); n = 36) and healthy controls (control group (CG); n = 36). Each group was randomly assigned to the oral supplementation of one pill/day (+) containing DHA-TG (n = 18) or no-pill condition (−) (n = 17) for three consecutive months. Data from demographics, risk factors, comorbidities, eye complications and therapy were recorded. Blood was collected and processed to determine pro-inflammatory biomarkers by bead-base multiplex assay. Statistical processing with multivariate statistical analysis was performed. The mean age was 50, 12 (10, 31) years. The distribution by gender was 45% males and 55% females. The mean number of uveitis episodes was 5 (2). Higher plasma expression of interleukin (IL)-6 was detected in the UG versus the CG (p = 5 × 10−5). Likewise, significantly higher plasma levels were seen for IL-1β, IL-2, INFγ (p = 10−4), and TNFα (p = 2 × 10−4) in the UG versus the CG. Significantly lower values of the above molecules were found in the +DHA-TG than in the -DHA-TG subgroups, after 3 months of follow-up, TNFα (p = 10−7) and IL-6 (p = 3 × 10−6) being those that most significantly changed. Signatures of circulating inflammatory mediators were obtained in the quiescent stage of recurrent NIAU patients. This 3-month follow-up strongly reinforces that a regular oral administration of DHA-TG reduces the inflammatory load and may potentially supply a prophylaxis-adjunctive mediator for patients at risk of uveitis vision loss.

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Noninfectious uveitis: strategies to optimize treatment compliance and adherence

Cited by 7 publications

References 34 publications

Adherence to Topical Medication in Patients with Inflammatory Eye Disease

Adherence to Topical Medication in Patients with Inflammatory Eye Disease

Effectiveness of long-term infliximab use and impact of treatment adherence on disease control in refractory, non-infectious pediatric uveitis

Signature of Circulating Biomarkers in Recurrent Non-Infectious Anterior Uveitis. Immunomodulatory Effects of DHA-Triglyceride. A Pilot Study

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