Quality of Life in Patients with Noninfectious Uveitis Treated with or without Systemic Anti-inflammatory Therapy

Gui, Weihua; Dombrow, Matthew; Marcus, Inna; Stowe, Meredith H.; Tessier‐Sherman, Baylah; Yang, Elizabeth; Huang, John J.

doi:10.3109/09273948.2013.874445

Cited by 25 publications

(22 citation statements)

References 30 publications

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“…Non-infectious uveitis (NIU) is an umbrella term for a family of intraocular inflammatory conditions that collectively affect more than one in 1,000 individuals and account for ~10% of preventable blindness in Western countries ( 1 , 2 ). This typically recurrent or chronic disorder may lead to poor visual outcome and low quality of life if undertreated ( 3 , 4 ). Although corticosteroids (either local or systemically) remain the therapy of first choice, long term use is hampered by many side effects ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

High-Dimensional Profiling Reveals Heterogeneity of the Th17 Subset and Its Association With Systemic Immunomodulatory Treatment in Non-infectious Uveitis

et al. 2018

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Background: Non-infectious uveitis (NIU) is a severe intra ocular inflammation, which frequently requires prompt systemic immunosuppressive therapy (IMT) to halt the development of vision-threatening complications. IMT is considered when NIU cannot be treated with corticosteroids alone, which is unpredictable in advance. Previous studies have linked blood cell subsets to glucocorticoid sensitivity, which suggests that the composition of blood leukocytes may early identify patients that will require IMT.Objective: To map the blood leukocyte composition of NIU and identify cell subsets that stratify patients that required IMT during follow-up.Methods: We performed controlled flow cytometry experiments measuring a total of 37 protein markers in the blood of 30 IMT free patients with active non-infectious anterior, intermediate, and posterior uveitis, and compared these to 15 age and sex matched healthy controls. Results from manual gating were validated by automatic unsupervised gating using FlowSOM.Results: Patients with uveitis displayed lower relative frequencies of Natural Killer cells and higher relative frequencies of memory T cells, in particular the CCR6+ lineages. These results were confirmed by automatic gating by unsupervised clustering using FlowSOM. We observed considerable heterogeneity in memory T cell subsets and abundance of CXCR3-CCR6+ (Th17) cells between the uveitis subtypes. Importantly, regardless of the uveitis subtype, patients that eventually required IMT in the course of the study follow-up exhibited increased CCR6+ T cell abundance before commencing therapy.Conclusion: High-dimensional immunoprofiling in NIU patients shows that clinically distinct forms of human NIU exhibit shared as well as unique immune cell perturbations in the peripheral blood and link CCR6+ T cell abundance to systemic immunomodulatory treatment.

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Section: Introductionmentioning

confidence: 99%

High-Dimensional Profiling Reveals Heterogeneity of the Th17 Subset and Its Association With Systemic Immunomodulatory Treatment in Non-infectious Uveitis

et al. 2018

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“…21 Several studies have focused on the effect of uveitis symptoms on quality-of-life outcomes. [22][23][24][25][26][27] Given that both uveitis and corticosteroid therapy are related to an increased likelihood of complications, it may be difficult to determine disease vs treatment effect on comorbidity and quality of life. Moreover, noninfectious uveitis is associated with a number of systemic disorders, including Behçet disease, juvenile idiopathic arthritis, rheumatoid arthritis, Vogt-Koyanagi-Harada disease, sarcoidosis, ankylosing spondylitis, psoriatic arthritis, and multiple sclerosis.…”

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confidence: 99%

Effect of Adalimumab on Visual Functioning in Patients With Noninfectious Intermediate Uveitis, Posterior Uveitis, and Panuveitis in the VISUAL-1 and VISUAL-2 Trials

et al. 2017

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INTERVENTIONS In VISUAL-1 and VISUAL-2, patients were randomized to receive adalimumab, 80-mg, subcutaneous loading dose followed by 40 mg every other week or placebo for 80 weeks. All patients underwent prednisone tapering, with patients in VISUAL-1 receiving an initial prednisone burst. MAIN OUTCOMES AND MEASURES The 25-item National Eye Institute Vision Function Questionnaire (NEI VFQ-25) composite score questionnaire assessed the impact of visual impairment from the patient's perspective; scores on the questionnaire range from 0 to 100, with higher scores indicating better vision-related quality of life. The change in NEI VFQ-25 from best state achieved prior to week 6 (VISUAL-1) and from baseline state (VISUAL-2) to the final or early termination visit was determined in each group and statistically compared using analysis of variance. The temporal effects of adalimumab and placebo on NEI VFQ-25 were investigated using a longitudinal model. RESULTS Of the 217 patients in VISUAL-1, 124 (57.1%) were women; the mean (SD) age was 42.7 (14.9) years. Of the 226 patients in VISUAL-2, 138 (61.1%) were women; the mean (SD) age was 42.5 (13.4). In VISUAL-1, the change from final score to best score in NEI VFQ-25 was −1.30 for adalimumab and −5.50 for placebo-a difference of 4.20 (95% CI, 1.04 to 7.36; P = .01) associated with adalimumab compared with placebo. In VISUAL-2, the change from baseline NEI VFQ-25 was 3.36 for adalimumab and 1.24 for placebo-a difference of 2.12 (95% CI, −0.81 to 5.04; P = .16). In both trials, the longitudinal models showed a significant difference in NEI VFQ-25 between adalimumab and placebo of 3.07 (95% CI, 2.09 to 4.06; P < .001) and 4.66 (95% CI, 0.05 to 9.26; P = .048) in the VISUAL-1 (74.15 vs 71.08) and VISUAL-2 (82.39 vs 77.73) trials, respectively. CONCLUSIONS AND RELEVANCE This post hoc analysis suggests that adalimumab is associated with statistically significant and clinically meaningful improvements in patient-reported visual functioning for patients with noninfectious intermediate uveitis, posterior uveitis, and panuveitis.

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“…Medications include frequent eye drops (mydriatics and intraocular steroids), ocular injections, and systemic immunosuppressive therapy administered by injections or infusions. Interestingly, although these can potentially affect quality of life and function, a study in adults with uveitis demonstrated that those on systemic therapy had similar vision related and health related quality of life as those not on systemic therapy 5 . However, the effects of medication for uveitis in children are virtually unknown.…”

Section: Vision Related Quality Of Life and Functionmentioning

confidence: 99%

Quality-of-Life Metrics in Pediatric Uveitis

Angeles‐Han

2015

International Ophthalmology Clinics

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Uveitis can lead to vision loss and blindness in children. It can significantly impact a child’s vision related quality of life and daily function. Outcome studies in pediatric uveitis focus on the clinical ocular exam and general measures of quality of life whereas in adults, measures of visual function are incorporated. Adequate vision can affect a child’s daily activities and is crucial for daily function in the home and school. A comprehensive approach that incorporates all aspects of disability could improve the assessment of outcomes and may help us better understand the impact of visual impairment on children with uveitis.

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Quality of Life in Patients with Noninfectious Uveitis Treated with or without Systemic Anti-inflammatory Therapy

Abstract: Systemic therapy can be effectively used to control serious cases of noninfectious uveitis without significant relative adverse impact on quality of life.

Cited by 25 publications

References 30 publications

High-Dimensional Profiling Reveals Heterogeneity of the Th17 Subset and Its Association With Systemic Immunomodulatory Treatment in Non-infectious Uveitis

High-Dimensional Profiling Reveals Heterogeneity of the Th17 Subset and Its Association With Systemic Immunomodulatory Treatment in Non-infectious Uveitis

Effect of Adalimumab on Visual Functioning in Patients With Noninfectious Intermediate Uveitis, Posterior Uveitis, and Panuveitis in the VISUAL-1 and VISUAL-2 Trials

Quality-of-Life Metrics in Pediatric Uveitis

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