Review of Systemic Immunosuppression for Autoimmune Uveitis

Abstract

The purpose of this review is to comprehensively examine the various therapeutic agents available to treat autoimmune eye disease, their indications, clinical safety and recent developments. The stepladder approach is reviewed, including corticosteroid administration of various forms, classic immunomodulators, and newer biologic response modifiers. The authors present that corticosteroid monotherapy is almost never curative and carries significant side effects, while immunomodulatory therapy, when used appropriately as way to induce steroid-free remission, carries far less risk of causing long-term complications and provides greater potential of altering the immune system to induce a durable remission.Electronic supplementary materialThe online version of this article (doi:10.1007/s40123-014-0023-x) contains supplementary material, which is available to authorized users.

Treatment of Uveitis by In Situ Administration of Ex Vivo–Activated Polyclonal Regulatory T Cells

“…These patients are usually treated with corticosteroids, immunosuppressive drugs, or biological agents. However, these treatments have important side effects and are sometimes not efficient (58). Alternative treatments have to be proposed when all current therapeutic options have failed.…”

Casos clínicos de uveítis del Hospital México, 2010-2013

“…En la mayoría de casos se utilizan tratamientos antiinflamatorios tópicos como colirios específicos con drogas esteroidales y no esteroidales, pero en muchos pacientes es necesaria una intervención farmacológica más agresiva, con inmunosupresores sistémicos como los corticosteroides. 19 Entre los fármacos inmunomoduladores que pueden emplearse en uveítis se encuentran: antimetabolitos como metotrexate, azatioprina y micofenolato de mofetil; inhibidores de calcineurina, como ciclosporina y tacrolimus; agentes alquilantes, como ciclofosfamida y clorambucilo, y agentes biológicos modificadores de la respuesta inmune, como anticuerpos monoclonales específicos y gammaglobulina. [20][21][22] Aunque la terapia de elección para las crisis agudas y las exacerbaciones de uveítis es la de los corticosteroides, la meta terapéutica es alcanzar y mantener una remisión libre de esteroides, lo cual puede lograrse con los agentes quimioterapéuticos citados.…”

Genetics and immunodysfunction underlying Behçet’s disease and immunomodulant treatment approaches

“…Lipocortin prevents the of phospholipase A 2 activity, thereby reducing the formation/release of arachidonic acid precursor for prostanoids and leukotrienes. These actions of corticosteroids on arachidonic acid metabolism and on cytokine formation ultimately give rise to the important anti-inflammatory, immunosuppressive and antimitogenic special effects (Kragballe 1988;Castiblanco and Foster 2014) that make them useful for the treatment of BD.…”