Recent developments in the treatment of uveitis: an update

Lyon, Fiona; Gale, Richard; Lightman, Susan

doi:10.1517/14728220902852570

Cited by 21 publications

(12 citation statements)

References 62 publications

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“…For these reasons, refractory uveitis usually requires early and aggressive treatment. Immunomodulatory therapy is often needed in order to preserve visual acuity and to prevent significant morbidity of chronic steroid administration (2). Recently, tumor necrosis factor α (TNFα)–blocking agents have been used to treat chronic, refractory uveitis in adulthood as well as in childhood (3).…”

Section: Introductionmentioning

confidence: 99%

Prevention of flare recurrences in childhood‐refractory chronic uveitis: An open‐label comparative study of adalimumab versus infliximab

Simonini¹,

Taddio²,

Cattalini³

et al. 2011

Arthritis Care & Research

185

114

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Objective. To compare the efficacy and safety of adalimumab versus infliximab in an open-label prospective, comparative, multicenter cohort study of childhood noninfectious chronic uveitis. Methods. Thirty-three patients (22 females, 11 males, median age 9.17 years) with refractory, vision-threatening, noninfectious active uveitis were enrolled, and received for at least 1 year infliximab (5 mg/kg at weeks 0, 2, and 6, and then every 6 -8 weeks) or adalimumab (24 mg/m 2 every 2 weeks). The primary outcome was to assess, once remission was achieved, the time of a first relapse. Time to remission, time to steroid discontinuation, and the number of relapses were also considered. Results. Sixteen children (12 with juvenile idiopathic arthritis [JIA], 3 with idiopathic uveitis, and 1 with Behçet's disease) were recruited in the adalimumab cohort and 17 children (10 with JIA, 5 with idiopathic uveitis, 1 with early-onset sarcoidosis, and 1 with Behçet's disease) were recruited in the infliximab group. Cox regression analysis did not show statistically significant differences between the two groups with regard to time to achieve remission and time to steroid discontinuation, whereas a higher probability of uveitis remission on adalimumab during the time of treatment was shown (Mantel-Cox 2 ‫؍‬ 6.83, P < 0.001). At 40 months of followup, 9 (60%) of 15 children receiving adalimumab compared to 3 (18.8%) of 16 children receiving infliximab were still in remission on therapy (P < 0.02). Conclusion. Even if limited to a relatively small group, our study suggests that over 3 years of treatment, adalimumab is more efficacious than infliximab in maintaining remission of chronic childhood uveitis.

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Section: Introductionmentioning

confidence: 99%

Prevention of flare recurrences in childhood‐refractory chronic uveitis: An open‐label comparative study of adalimumab versus infliximab

Simonini¹,

Taddio²,

Cattalini³

et al. 2011

Arthritis Care & Research

185

114

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“…), daclizumab (Zenepax, Hoffman-La Roche, Nutley, N.J.) and adalimumab (Humira, Abbott, North Chicago, Ill.). 3,4 There are also early reports within the literature on the use of rituximab in the treatment of Wegener’s granulomatosus and primary intraocular lymphoma. 5,6 Cytokines such as tumor necrosis factor α (TNFα) and interleukin-2 (IL-2) are important factors in the development of intraocular inflammation and the use of biologic agents to inhibit these factors may be considered when standard therapies are insufficient or intolerable to patients.…”

mentioning

confidence: 99%

Long-term daclizumab therapy for the treatment of noninfectious ocular inflammatory disease

Wroblewski

Sen

Yeh

et al. 2011

Canadian Journal of Ophthalmology

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Objective Safety and efficacy of daclizumab during an 11-year period. Design Structured, retrospective chart review. Participants Thirty-nine patients. Methods Patients with chronic, noninfectious intermediate and/or posterior uveitis. Results Thirty-nine patients (78 eyes) were treated for a mean of 40.3 months. Visual acuity improved by ≥2 lines in the better eye in 7 patients (18.4%) and worsened by 2 lines in 6 patients (15.8%) with a mean of 2.8 Snellen lines of vision lost per eye. Six eyes with vitreous cell less than grade 2 lost 2 lines of vision and 7 eyes with less than grade 2 vitreous cell improved 2 lines. Mean number of immunosuppressive medications per patient decreased from 1.89 medications/patient to 1.17 medications/patient. The average number of periocular injections per patient was 1.46 (range, 0–9). The mean number of flares was 2.05/patient (range, 0–12), with the rate being 0.62 flares per patient-year. Four patients developed cancer during the course of this study. Mean time to onset of malignancy was 26 months and the mean age in this group was 49 years. Conclusions Daclizumab demonstrated efficacy in the reduction of concomitant immunosuppressive medication, stabilization of visual acuity, and the prevention of uveitic flares in most cases. Dermatologic complications were the most frequently observed adverse event in our series. Four patients developed solid tumor malignancies during this 11-year period.

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“…Systemic corticosteroids are generally advocated for intermediate and posterior uveitis that requires treatment that is either bilateral or associated with systemic disease [12,13,14]. Where possible, oral administration is preferred over intravenous administration for its ease of use and lack of requirement for hospital admission.…”

Section: Systemic Corticosteroid Administrationmentioning

confidence: 99%

New Developments in Corticosteroid Therapy for Uveitis

et al. 2010

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Corticosteroids remain the mainstay of the management of patients with uveitis. Topical corticosteroids are effective in the control of anterior uveitis, but vary in strength, ocular penetration and side effect profile. Systemic corticosteroids are widely used for the management of posterior segment inflammation which requires treatment, particularly when it is associated with systemic disease or when bilateral ocular disease is present. However, when ocular inflammation is unilateral, or is active in one eye only, local therapy has considerable advantages, and periocular injections of corticosteroid are a useful alternative to systemic medication and are very effective in controlling mild or moderate intraocular inflammation. More recently, the injection of intraocular corticosteroids such as triamcinolone have been found to be effective in reducing macular oedema and improving vision in uveitic eyes which have proved refractory to systemic or periocular corticosteroids. The effect is usually transient, lasting around 3 months, but can be repeated although the side effects of cataract and raised intraocular pressure are increased in frequency with intraocular versus periocular corticosteroid injections. This has led to the development of new intraocular corticosteroid devices which are designed to deliver sustained-release drugs and obviate the need for systemic immunosuppressive treatment. The first such implant was Retisert, which is surgically implanted (in the operating theatre) and is designed to release fluocinolone over a period of about 30 months. More recently, Ozurdex, a ‘bioerodible’ dexamethasone implant which can be inserted in an office setting, has completed phase III clinical trials in patients with intermediate and posterior uveitis. This implant lasts approximately 6 months, and has been found to be effective with a much better side effect profile than Retisert or intravitreal triamcinolone injection, at least for one injection.

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Recent developments in the treatment of uveitis: an update

Cited by 21 publications

References 62 publications

Prevention of flare recurrences in childhood‐refractory chronic uveitis: An open‐label comparative study of adalimumab versus infliximab

Prevention of flare recurrences in childhood‐refractory chronic uveitis: An open‐label comparative study of adalimumab versus infliximab

Long-term daclizumab therapy for the treatment of noninfectious ocular inflammatory disease

New Developments in Corticosteroid Therapy for Uveitis

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