Rescue therapy with mycophenolate mofetil in refractory uveitis

Kilmartin, Dara J.; Forrester, John V.; Dick, Andrew D.

doi:10.1016/s0140-6736(05)79515-5

Cited by 109 publications

(48 citation statements)

References 4 publications

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“…Over the last few years, assisted by major expert opinion overview articles that provided treatment recommendations, 49 there have been further seminal trials and patient cohort studies highlighting the evidence for treatment with non-biologic conventional immunosuppressants. 4,7,[50][51][52][53][54][55][56][57][58] The most compelling studies of recent years include evidence from patient cohort analytical studies for the use of cellcept displaying its effectiveness as a corticosteroid-sparing agent with an acceptable adverse event profile. 4,7,59 In particular, there are two studies that presented their results in accordance with SUN guidelines showing concordance in effect, with around an 80% chance of achieving disease control at a prednisolone dose of o10 mg/day.…”

Section: Treatment Outcomes To Datementioning

confidence: 99%

Current concepts and future directions in the pathogenesis and treatment of non-infectious intraocular inflammation

Lee

Dick

2011

Eye

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The blockbuster drug paradigm is under increasing scrutiny across the biopharmaceutical industry. Intraocular inflammation poses particular challenges to this, given the heterogeneity of conditions in the uveitis spectrum, and the increasing acknowledgement of individual patient and disease variance in underlying immune responses. This need has triggered a drive towards personalised and stratified medicine, supported and enabled as a result of continued development of both experimental models and molecular biological techniques and improved clinical classification. As such we have the ability now to systematically appraise at a genomic, transcriptomic, and proteomic level individual immunophenotype, and the promise that in the eye this can be augmented by in vivo immune imaging to identify individual immunopathology. With such advances all running in parallel, we are entering an era of experimental medicine that will facilitate early diagnosis, generate biomarkers for accurate prognostication, and enable the development of individualised and targeted therapies, which can progress rapidly into clinical practice.

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Section: Treatment Outcomes To Datementioning

confidence: 99%

Current concepts and future directions in the pathogenesis and treatment of non-infectious intraocular inflammation

Lee

Dick

2011

Eye

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“…9 In patients who are refractory to corticosteroid treatment, immunosuppressive drugs may play a bigger role in inflammation control 31 and may sometimes even serve as a rescue therapy. [41][42] Immunosuppressive agents have historically been introduced into clinical practice of uveitis with reference to their success in controlling other autoimmune inflammatory disorders and transplant rejection, 14,43 and in the field of ocular inflammation, almost all are used off-label. 43 Although there has been a large body of evidences showing the advantages of immunosuppressive drugs in treatment of uveitis, indications for selection of one immunosu- …”

Section: Conventional Immunosuppressive Agentsmentioning

confidence: 99%

“…42 Despite its limited experiences in practice of uveitis, this drug has gained considerable popularity, reflected by the emerging publications on its effectiveness in this particular field, 44,[97][98][99][100][101][102][103] as well as its second priority among uveitis specialists' current choices of immunosuppressive drugs in the United…”

Section: Mmfmentioning

confidence: 99%

Immunosuppressive Treatment of Non-infectious Uveitis: History and Current Choices

Zhao¹,

Zhang²

2017

cmsj

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Non-infectious uveitis is one of the leading causes of preventable blindness worldwide. Long-term immunosuppressive treatment is generally required to achieve durable control of inflammation in posterior and panuveitis. Although systemic corticosteroids have been the gold standard of immunosuppressive treatment for uveitis since first introduced in 1950s, its side effects of long-term use often warrant an adjuvant treatment to reduce the dosage/duration of corticosteroids needed to maintain disease control. Conventional immunosuppressive drugs, classified into alkylating agent, antimetabolites and T cell inhibitors, have been widely used as corticosteroid-sparing agents, each with characteristic safety/tolerance profiles on different uveitis entities. Recently, biologic agents, which target specific molecules in immunopathogenesis of uveitis, have gained great interest as alternative treatments for refractory uveitis based on their favorable safety and effectiveness in a variety of uveitis entities. However, lack of large randomized controlled clinical trials, concerns about efficacy and safety of long-term usage, and economic burden are limiting the use of biologics in non-infectious uveitis. Local administration of immunosuppressive drugs (from corticosteroids to biologics) through intraocular drug delivery systems represent another direction for drug development and is now under intense investigation, but more evidences are needed to support their use as regular alternative treatments for uveitis. With the numerous choices belonging to different treatment modalities (conventional immunosuppressive agents, biologics and local drug delivery systems) on hand, the practice patterns have been reported to vary greatly from center to center. Factors influence uveitis specialists' choices of immunosuppressive agents may be complex and may include personal familiarity, treatment availability, safety/tolerability, effectiveness, patient compliance, cost concerns and suggestions from related specialists such as rheumatologists and pediatricians. The focus of this review is to provide an overview of each treatment modality on safety/tolerability and effectiveness, which are believed to be the two most important factors affecting treatment decision making.

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“…By decreasing guanosine nucleotides, MMF also suppresses the expression of vascular endothelial adhesion molecules, which decreases recruitment of lymphocytes and monocytes to sites of inflammation. MMF use in ocular inflammation was first explored in animal models of experimental autoimmune uveoretinitis (Chanaud et al 1995), leading to a number of studies supporting its use in refractory human inflammatory eye diseases, including noninfectious uveitis and scleritis (Kilmartin et al 1998b;Larkin and Lightman 1999;Sen et al 2003;Greiner et al 2002;Lau et al 2003;Baltatzis et al 2003;Siepman et al 2006;Thorne et al 2005;Teoh et al 2008). Doycheva and colleagues conducted a retrospective case series of 60 uveitis patients treated with MMF for at least 5 years and found that control of inflammation was achieved in 72% of patients after 1 year of treatment and in 82% after 2 years (Doycheva et al 2011).…”

Section: Mycophenolate Mofetilmentioning

confidence: 99%