Uveitis
Overall and cancer related mortality among patients with ocular inflammation treated with immunosuppressive drugs: retrospective cohort study (SITE Cohort Study), 2008 ⏩
n=2340, 66802 person years
Study question: Retrospective cohort study evaluating overall and cancer mortality in relation to immunosuppressive drug exposure among patients with ocular inflammatory diseases
Study results: Patients who used azathioprine, methotrexate, mycophenolate mofetil, ciclosporin, systemic corticosteroids, cyclophosphamide, or dapsone had overall and cancer mortality similar to that of patients who never took immunosuppressive drugs. Tumour necrosis factor inhibitors were associated with increased overall and cancer mortality (HR of 2 and 3.83).
Practical approach to the use of corticosteroids in patients with uveitis, 2010 ⏩
and
Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel, 2000 ⏩
Thought theseis not a clinical trials, these articles described the ground rules for treatments in uveitis. These are the fundamentals of treating uveitis. For example the tapering down regime of oral prednisone: 0.5-1.5 mg/kg, taper bi-weekly or q2w. 20mg reduction to 40mg/day. Then reduce 10mg to 20mg/day. Then steps of 1-5mg to the lowest possible.
Evaluation of an intravitreal fluocinolone acetonide implant versus standard systemic therapy in noninfectious posterior uveitis, 2010 ⏩
n=140
Study question: Unilateral or bilateral NIPU for either 0.59 Iluvien VS standard of care.
Study results: Eyes that received the FA intravitreal implant experienced delayed onset of observed recurrence of uveitis and a lower rate of recurrence of uveitis (18.2% vs. 63.5%). Elevated IOP requiring IOP-lowering surgery occurred in 21.2% of implanted eyes and cataracts requiring extraction on 87.8% of phakic implanted eyes.
Randomized Comparison of Systemic Anti-inflammatory Therapy Versus Fluocinolone Acetonide Implant for Intermediate, Posterior, and Panuveitis: The Multicenter Uveitis Steroid Treatment Trial (MUST), 2011 ⏩
n=479, 24m
Study question: systemic or implant steroid tx for or noninfectious intermediate, posterior, or panuveitis. Study results: improvement in visual acuity of +6.0 (implant) vs +3.2 letters. Implant superior in improvement in vision-related quality of life. Residual active uveitis in the implant group was 12% vs 29%. Implant caused higher risk of cataract surgery, need for elevates IOP and glaucoma. Systemic therapy had more prescription-requiring infections.
Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis (Ozurdex HURON Study Group), 2011 ⏩
n=229, 24w
Study Question: Sham VS 0.35mg VS 0.7mg dexamethasone intravitreal implant (DEX implant) for noninfectious intermediate or posterior uveitis.
Study results: The proportion of eyes with a vitreous haze score of 0 at week 8 was 47% with the 0.7-mg DEX, 36% with the 0.35-mg, and 12% with the sham (main outcome measure). This benefit persisted through week 26. A gain of 15 or more letters from baseline BCVA was significantly more eyes in the implant groups. No significant IOP elevation (25+): 7.1% for the 0.7-mg DEX, 8.7% for the 0.35-mg, and 4.2% for sham. More, but not significant catarat formation 15% with the 0.7-mg DEX, 12% with the 0.35-mg, 7% with the sham.
Adalimumab plus Methotrexate for Uveitis in Juvenile Idiopathic Arthritis (SYCAMORE), 2017 ⏩
n=90, 2y
Study question: Adalimumab (Humira) VS sham for uveitis 2nd to Juvenile idiopathic arthritis (JIA). All patients were on a stable dose of methotrexate.
Study result: Treatment failures in 27% in the adalimumab group versus 60%. Significantly more adverse events in patients receiving adalimumab. Basing Humira as treatment for JIA.
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n=2340, 66802 person years
Study question: Retrospective cohort study evaluating overall and cancer mortality in relation to immunosuppressive drug exposure among patients with ocular inflammatory diseases
Study results: Patients who used azathioprine, methotrexate, mycophenolate mofetil, ciclosporin, systemic corticosteroids, cyclophosphamide, or dapsone had overall and cancer mortality similar to that of patients who never took immunosuppressive drugs. Tumour necrosis factor inhibitors were associated with increased overall and cancer mortality (HR of 2 and 3.83).
Practical approach to the use of corticosteroids in patients with uveitis, 2010 ⏩
and
Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel, 2000 ⏩
Thought theseis not a clinical trials, these articles described the ground rules for treatments in uveitis. These are the fundamentals of treating uveitis. For example the tapering down regime of oral prednisone: 0.5-1.5 mg/kg, taper bi-weekly or q2w. 20mg reduction to 40mg/day. Then reduce 10mg to 20mg/day. Then steps of 1-5mg to the lowest possible.
Evaluation of an intravitreal fluocinolone acetonide implant versus standard systemic therapy in noninfectious posterior uveitis, 2010 ⏩
n=140
Study question: Unilateral or bilateral NIPU for either 0.59 Iluvien VS standard of care.
Study results: Eyes that received the FA intravitreal implant experienced delayed onset of observed recurrence of uveitis and a lower rate of recurrence of uveitis (18.2% vs. 63.5%). Elevated IOP requiring IOP-lowering surgery occurred in 21.2% of implanted eyes and cataracts requiring extraction on 87.8% of phakic implanted eyes.
Randomized Comparison of Systemic Anti-inflammatory Therapy Versus Fluocinolone Acetonide Implant for Intermediate, Posterior, and Panuveitis: The Multicenter Uveitis Steroid Treatment Trial (MUST), 2011 ⏩
n=479, 24m
Study question: systemic or implant steroid tx for or noninfectious intermediate, posterior, or panuveitis. Study results: improvement in visual acuity of +6.0 (implant) vs +3.2 letters. Implant superior in improvement in vision-related quality of life. Residual active uveitis in the implant group was 12% vs 29%. Implant caused higher risk of cataract surgery, need for elevates IOP and glaucoma. Systemic therapy had more prescription-requiring infections.
Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis (Ozurdex HURON Study Group), 2011 ⏩
n=229, 24w
Study Question: Sham VS 0.35mg VS 0.7mg dexamethasone intravitreal implant (DEX implant) for noninfectious intermediate or posterior uveitis.
Study results: The proportion of eyes with a vitreous haze score of 0 at week 8 was 47% with the 0.7-mg DEX, 36% with the 0.35-mg, and 12% with the sham (main outcome measure). This benefit persisted through week 26. A gain of 15 or more letters from baseline BCVA was significantly more eyes in the implant groups. No significant IOP elevation (25+): 7.1% for the 0.7-mg DEX, 8.7% for the 0.35-mg, and 4.2% for sham. More, but not significant catarat formation 15% with the 0.7-mg DEX, 12% with the 0.35-mg, 7% with the sham.
Adalimumab plus Methotrexate for Uveitis in Juvenile Idiopathic Arthritis (SYCAMORE), 2017 ⏩
n=90, 2y
Study question: Adalimumab (Humira) VS sham for uveitis 2nd to Juvenile idiopathic arthritis (JIA). All patients were on a stable dose of methotrexate.
Study result: Treatment failures in 27% in the adalimumab group versus 60%. Significantly more adverse events in patients receiving adalimumab. Basing Humira as treatment for JIA.
-----------------------------------
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🚩 If you want to comment please use the form at the bottom of this page
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