The Treatment of Uveitis with Six-Mercaptopurine*

Newell, Frank W.; Krill, Alex E.; Thomson, Andrew C.

doi:10.1016/0002-9394(66)90253-4

Cited by 38 publications

(11 citation statements)

References 14 publications

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“…In particular, the literature notes its efficacy for the treatment of scleritis associated with polychondritis, ocular cicatricial pemphigoid, pars planitis, and JIA-associated iridocyclitis [20,66,78,80]. In a 2-year doublemasked, randomized, controlled study, it was demonstrated that azathioprine (2.5 mg/ kg/day) was able to prevent the formation of new eye lesions and reduce the frequency and intensity of inflammation in patients with ABD [81].…”

Section: Therapeutic Effectsmentioning

confidence: 97%

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Corticosteroid-Sparing Agents: Conventional Systemic Immunosuppressants

Kruh

Foster²

2012

Developments in Ophthalmology

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The introduction of corticosteroids in the mid-20th century to control inflammatory eye disease revolutionized treatment practices. As long-term use of corticosteroids became the backbone of immunosuppressive therapy, it soon became evident that it was associated with significant morbidity to the patient. For this reason, other immunosuppressant agents were sought. Thereafter, the first generation of immunosuppressive agents were born. The main action of all such agents involves the inhibition of lymphoid proliferation. The agents can be further subdivided into the following categories based on their specific mechanism of action: alkylating (cyclophosphamide and chlorambucil), antimetabolite (methotrexate, mycophenolate mofetil and azathioprine), and antibiotic/calcineurin inhibitor (cyclosporine, tacrolimus and sirolimus). These immunomodulating agents serve as the foundation to modern corticosteroid-sparing immunosuppressive therapy. Many times, these agents are now even indicated as first-line therapy for the treatment of systemic inflammatory diseases with destructive ocular sequela, e.g. Behçet's disease and granulomatosis with polyangiitis (Wegener's). Choosing the most appropriate immunomodulatory agent to initiate therapy can often be difficult; a multifactorial approach in the decision-making process is essential. Special attention must be given to the patient's medical history, type and severity of inflammatory disease, social history, compliance, age, and sex. Oftentimes, it takes a joint effort between the ophthalmologist and multiple sub-specialists (rheumatology, oncology, and hematology) to administer and monitor these therapies. Even though each of these systemic immunosuppressive agents has its own array of potential side effects, with careful monitoring and titration of dosages, such potential side effects can be minimized or avoided altogether. Ultimately, these patients are afforded a much more favorable longterm outcome, free of the devastating effects of chronic corticosteroid use.

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Section: Therapeutic Effectsmentioning

confidence: 97%

“…However, Foster found more equivocal efficacy in a series of 8 patients treated similarly [82]. There has also been varying results for its use in the treatment of sympathetic ophthalmia [24,78].…”

Section: Therapeutic Effectsmentioning

confidence: 98%

Corticosteroid-Sparing Agents: Conventional Systemic Immunosuppressants

Kruh

Foster²

2012

Developments in Ophthalmology

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“…When given before the antigenic challenge, it is supposed to have a greater effect on the afferent arm of the immune response. It affects Th1 response mainly (175). Reports indicate its efficacy in the long-term prognosis of BD as well as in prevention of new eye disease in BD patients in whom eye involvement has not yet occurred (176,177).…”

Section: Antimetabolitesmentioning

confidence: 97%

Immunopathogenesis of Behçet's Disease

Hegab¹,

Al-Mutawa²

2000

Clinical Immunology

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“…Yukio et al reported the number of acute uveitis episodes during the 6 months after infliximab administration was significantly lower than CsA in ABD [91]. Similarly, Khalid et al reported a significant decrease in inflammation, an improvement in visual acuity, and reduced ocular complications following infliximab when compared to conventional therapy with a combination of oral prednisolone, CsA, and azathioprine, or methotrexate [144]. Other clinical studies suggest that infliximab be used as the first-line therapy in patients with ABD [145,146].…”

Section: When To Consider the Use Of Biologics In Non-infectious Uveimentioning

confidence: 90%

The role of biologic agents in the management of non-infectious uveitis

Heo¹,

Sepah²,

Yohannan³

et al. 2012

Expert Opinion on Biological Therapy

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We recommend that in general (except in selected cases of Adamantiades-Behçet's disease) biologics should not be used as a first-line therapy for uveitis due to inconvenience, high cost, and potential immunosuppressive effects. However, many biologics are potent in inducing drug-free remission of uveitis and may be employed to manage recurrent diseases or diseases not responsive to conventional agents.

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The Treatment of Uveitis with Six-Mercaptopurine*

Cited by 38 publications

References 14 publications

Corticosteroid-Sparing Agents: Conventional Systemic Immunosuppressants

Corticosteroid-Sparing Agents: Conventional Systemic Immunosuppressants

Immunopathogenesis of Behçet's Disease

The role of biologic agents in the management of non-infectious uveitis

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