The Use of Chlorambucil in Intractable Idiopathic Uveitis

Godfrey, William; Epstein, Wallace V.; O’Connor, G. Richard; Kimura, Samuel J.; Hogan, Michael J.; Nozik, Robert A.

doi:10.1016/0002-9394(74)90229-3

Cited by 81 publications

(9 citation statements)

References 16 publications

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“…Cyclophosphamide and chlorambucil In a few individual case reports, uveitis improved under treatment with cyclophosphamide [72][73][74] or chlorambucil [75][76][77]. However, very severe side effects developed in the patients (e.g., infertility, leukopenia, thrombocytopenia, zoster infection, and others) and thus insofar as possible these drugs should not be used to treat childhood uveitis (IIIA).…”

Section: Treatment With Immunosuppressives and Biologicalsmentioning

confidence: 97%

Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis

et al. 2011

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Uveitis in juvenile idiopathic arthritis (JIA) is frequently associated with the development of complications and visual loss. Topical corticosteroids are the first-choice therapy, and immunosuppression is commonly used. However, treatment has not been standardized. Representatives from the German Ophthalmological Society, Society for Childhood and Adolescent Rheumatology, and the German Society for Rheumatology reached consensus on a standardized treatment strategy according to disease severity in the individual patient. The recommendations were based on a systematic literature analysis in MEDLINE and consensus expert meetings. Evidence and recommendations were graded, and an algorithm for anti-inflammatory treatment and final statements confirmed in a Delphi method. An interdisciplinary, evidence-based treatment guideline for JIA uveitis is presented.

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Section: Treatment With Immunosuppressives and Biologicalsmentioning

confidence: 97%

Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis

et al. 2011

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“…It also has been shown to allow for long-term remission of this disease [41,42]. This agent may also have a significant role in the treatment of juvenile idiopathic arthritis (JIA)-associated iridocyclitis, and sympathetic ophthalmia [24,[43][44][45][46].…”

Section: Therapeutic Valuementioning

confidence: 99%

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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“…There are few pediatric series describing the use of chlorambucil at a low dose (0.1 mg/ kg), but this agent is not recommended in the current pediatric uveitis treatment guidelines [22]. Chlorambucil is beneficial in some children within 2 to 3 months of initiating therapy [34][35][36]. However, a series of seven children treated with chlorambucil reported a lack of efficacy in five of seven children with JRA-associated uveitis; severe adverse reactions were reported in three of these children [36].…”

Section: Treatmentmentioning

confidence: 97%

Clinical trials in pediatric uveitis

Agle¹,

Vazquez-Cobian²,

Lehman

2003

Curr Rheumatol Rep

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Uveitis associated with juvenile rheumatoid arthritis is the most common form of ocular inflammation in children. Prevention of permanent visual damage by this silent disease requires heightened awareness from pediatric rheumatologists and ophthalmologists. Early prediction of severity and prognosis will aid in the identification of those patients requiring more aggressive management. Generally, reports using immunosuppressives in this population are small, uncontrolled, and retrospective. Large-scale collaborative studies have been proposed and are underway. Hopefully, collaborations between pediatricians, pediatric rheumatologists, and ophthalmologists will allow the development of straightforward treatment guidelines for children suffering from chronic uveitis and its related complications.

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The Use of Chlorambucil in Intractable Idiopathic Uveitis

Cited by 81 publications

References 16 publications

Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis

Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis

Corticosteroid-Sparing Agents: Conventional Systemic Immunosuppressants

Clinical trials in pediatric uveitis

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