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The effects of intravitreal adalimumab injection on pseudophakic macular edema. BMC Res Notes 2020; 13:354. [PMID: 32711577 PMCID: PMC7382825 DOI: 10.1186/s13104-020-05197-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/18/2020] [Indexed: 01/12/2023] Open
Abstract
Objective Pseudophakic macular edema is a frequent complication following cataract surgery. Inflammation is a major etiologic factor in the development of pseudophakic cystoid macular edema. Tumor necrosis factor-alpha has an important role in ocular inflammation. Adalimumab (Humira) is an inhibitor of tumor necrosis factor-alpha that has been approved in the United States. An open-label, uncontrolled, prospective, interventional study of five consecutive patients (5 eyes) with cystoid macular edema who were treated with off-label intravitreal adalimumab at Khalili Hospital was conducted. Slit-lamp examination and optical coherence tomography were done for all patients. Results No statistically significant difference was detected between best corrected visual acuity and central macular thickness before and after injection in pseudophakic macular edema. One patient developed uveitis approximately 2 weeks after injection. Based on the results, adalimumab does not appear to be an effective treatment for pseudophakic macular edema, and it may cause uveitis. Caution should be exercised when using this drug. Trial registration Iranian Registry of Clinical Trials IRCT2016100430130N1, 2016.12.03, Retrospectively registered
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Goto H, Zako M, Namba K, Hashida N, Kaburaki T, Miyazaki M, Sonoda KH, Abe T, Mizuki N, Kamoi K, Brézin AP, Dick AD, Jaffe GJ, Nguyen QD, Inomata N, Kwatra NV, Camez A, Song AP, Kron M, Tari S, Ohno S. Adalimumab in Active and Inactive, Non-Infectious Uveitis: Global Results from the VISUAL I and VISUAL II Trials. Ocul Immunol Inflamm 2018; 27:40-50. [DOI: 10.1080/09273948.2018.1491605] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Masahiro Zako
- Department of Ophthalmology, Asai Hospital, Aichi, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Noriyasu Hashida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masanori Miyazaki
- Department of Ophthalmology, Kyushu University Graduate School of Medicine, Fukuoka, Japan
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Kyushu University Graduate School of Medicine, Fukuoka, Japan
| | - Toshiaki Abe
- Division of Clinical Cell Therapy, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Koju Kamoi
- Department of Ophthalmology & Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Antoine P. Brézin
- Centre d’ophtalmologie de l’Assistance Publique, Hôpitaux de Paris, Hôpital Cochin, Université Paris Descartes, Paris, France
| | - Andrew D. Dick
- University of Bristol, Bristol Eye Hospital, Bristol, United Kingdom, and National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and University College London, Institute of Ophthalmology, London, UK
| | - Glenn J. Jaffe
- Duke Eye Center, Duke University Hospital, Durham, North Carolina, USA
| | - Quan Dong Nguyen
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | | | | | - Anne Camez
- AbbVie Deutschland GmbH & Co KG, Ludwigshafen, Germany
| | | | - Martina Kron
- AbbVie Deutschland GmbH & Co KG, Ludwigshafen, Germany
| | - Samir Tari
- AbbVie Inc., North Chicago, Illinois, USA
| | - Shigeaki Ohno
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Calvo-Río V, Santos-Gómez M, Calvo I, González-Fernández MI, López-Montesinos B, Mesquida M, Adán A, Hernández MV, Maíz O, Atanes A, Bravo B, Modesto C, Díaz-Cordovés G, Palmou-Fontana N, Loricera J, González-Vela MC, Demetrio-Pablo R, Hernández JL, González-Gay MA, Blanco R. Anti-Interleukin-6 Receptor Tocilizumab for Severe Juvenile Idiopathic Arthritis-Associated Uveitis Refractory to Anti-Tumor Necrosis Factor Therapy: A Multicenter Study of Twenty-Five Patients. Arthritis Rheumatol 2017; 69:668-675. [DOI: 10.1002/art.39940] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 09/20/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Vanesa Calvo-Río
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), and University of Cantabria; Santander Spain
| | - Montserrat Santos-Gómez
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), and University of Cantabria; Santander Spain
| | | | | | | | | | | | | | - Olga Maíz
- Hospital Universitario Donostia; San Sebastian Spain
| | | | - Beatriz Bravo
- Hospitalario Universitario Virgen de las Nieves; Granada Spain
| | | | | | - Natalia Palmou-Fontana
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), and University of Cantabria; Santander Spain
| | - Javier Loricera
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), and University of Cantabria; Santander Spain
| | - M. C. González-Vela
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), and University of Cantabria; Santander Spain
| | - Rosalía Demetrio-Pablo
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), and University of Cantabria; Santander Spain
| | - J. L. Hernández
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), and University of Cantabria; Santander Spain
| | - Miguel A. González-Gay
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), and University of Cantabria; Santander Spain
| | - Ricardo Blanco
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), and University of Cantabria; Santander Spain
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Hersh AO, Cope S, Bohnsack JF, Shakoor A, Vitale AT. Use of Immunosuppressive Medications for Treatment of Pediatric Intermediate Uveitis. Ocul Immunol Inflamm 2016; 26:642-650. [PMID: 27960602 DOI: 10.1080/09273948.2016.1255340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To describe the treatment and outcomes of a cohort of pediatric intermediate uveitis (IU) patients, with a particular focus on the use of immunomodulatory therapy (IMT). METHODS The disease course, treatment, and outcomes of 39 pediatric IU patients treated in the Uveitis Clinic at the University of Utah from 1999 to 2012 were reviewed, retrospectively. RESULTS Mean age at presentation was 7.7 years (SD 3.1). In total, 95% had bilateral involvement. Out of 77 total eyes involved, the most frequent disease complications were ocular hypertension (0.71 events per person year, PPY), cataracts (events PPY = 0.39), and cystoid macular edema (events PPY = 0.33). A total of 20 patients received IMT; 19/20 were tapered off systemic corticosteroids without a uveitis recurrence; 75% of eyes had inactive disease at final follow-up (mean 37 months). CONCLUSIONS The use of IMT, including biologic therapies, may effectively manage disease inflammation and reduce steroid dosages in pediatric IU patients.
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Affiliation(s)
- Aimee O Hersh
- a Division of Rheumatology, Department of Pediatrics , University of Utah School of Medicine , Salt Lake City , Utah , USA
| | - Spencer Cope
- b University of Texas San Antonio, Center for Health Sciences , San Antonio , Texas , USA
| | - John F Bohnsack
- a Division of Rheumatology, Department of Pediatrics , University of Utah School of Medicine , Salt Lake City , Utah , USA
| | - Akbar Shakoor
- c Department of Ophthalmology , John A. Moran Eye Center, University of Utah School of Medicine , Salt Lake City , Utah , USA
| | - Albert T Vitale
- c Department of Ophthalmology , John A. Moran Eye Center, University of Utah School of Medicine , Salt Lake City , Utah , USA
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Balevic SJ, Rabinovich CE. Profile of adalimumab and its potential in the treatment of uveitis. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:2997-3003. [PMID: 27698552 PMCID: PMC5034916 DOI: 10.2147/dddt.s94188] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Uveitis refers to the presence of intraocular inflammation, and as a strict definition compromises the iris and ciliary body anteriorly and the choroid posteriorly (the uvea). Untreated, uveitis can lead to visual loss or blindness. The etiology of uveitis can include both infectious and noninfectious (usually immune-mediated) causes, the latter of which are often mediated predominantly by Th1 CD4+ T-cells that secrete proinflammatory cytokines. Tumor necrosis factor-alpha (TNF-α) is a proinflammatory cytokine involved in the pathogenesis of uveitis, which at high concentrations can cause excess inflammation and tissue damage. Adalimumab is a recombinant human IgG1 monoclonal antibody specific for human TNF-α. Historically, corticosteroids and methotrexate were used to treat uveitis; however, newer biologic agents such as adalimumab have revolutionized therapy for noninfectious uveitis. Adalimumab has shown efficacy in treating refractory uveitis in multiple settings, including idiopathic disease, juvenile idiopathic arthritis, sarcoidosis, Behçets disease, and uveitis secondary to spondyloarthropathies, among several other noninfectious uveitis conditions. In this paper, we will review the profile of adalimumab, the role of TNF-α in uveitis, discuss safety data, and summarize key articles evaluating the efficacy of adalimumab in treating uveitis secondary to the most commonly associated autoimmune diseases.
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Affiliation(s)
- Stephen J Balevic
- Department of Pediatric Rheumatology, Duke University Medical Center, Durham, NC, USA
| | - C Egla Rabinovich
- Department of Pediatric Rheumatology, Duke University Medical Center, Durham, NC, USA
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Nguyen QD, Merrill PT, Jaffe GJ, Dick AD, Kurup SK, Sheppard J, Schlaen A, Pavesio C, Cimino L, Van Calster J, Camez AA, Kwatra NV, Song AP, Kron M, Tari S, Brézin AP. Adalimumab for prevention of uveitic flare in patients with inactive non-infectious uveitis controlled by corticosteroids (VISUAL II): a multicentre, double-masked, randomised, placebo-controlled phase 3 trial. Lancet 2016; 388:1183-92. [PMID: 27542302 DOI: 10.1016/s0140-6736(16)31339-3] [Citation(s) in RCA: 322] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/19/2016] [Accepted: 07/21/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Non-infectious uveitis is a potentially sight-threatening ocular disorder caused by chronic inflammation and its complications. Therapeutic success is limited by systemic adverse effects associated with long-term corticosteroid and immunomodulator use if topical medication is not sufficient to control the inflammation. We aimed to assess the efficacy and safety of adalimumab in patients with inactive, non-infectious uveitis controlled by systemic corticosteroids. METHODS We did this multicentre, double-masked, randomised, placebo-controlled phase 3 trial at 62 study sites in 21 countries in the USA, Canada, Europe, Israel, Australia, and Latin America. Patients (aged ≥18 years) with inactive, non-infectious intermediate, posterior, or panuveitic uveitis controlled by 10-35 mg/day of prednisone were randomly assigned (1:1), via an interactive voice and web response system with a block size of four, to receive either subcutaneous adalimumab (loading dose 80 mg; biweekly dose 40 mg) or placebo, with a mandatory prednisone taper from week 2. Randomisation was stratified by baseline immunosuppressant treatment. Sponsor personnel with direct oversight of the conduct and management of the study, investigators, study site personnel, and patients were masked to treatment allocation. The primary efficacy endpoint was time to treatment failure, a multicomponent endpoint encompassing new active inflammatory chorioretinal or inflammatory retinal vascular lesions, anterior chamber cell grade, vitreous haze grade, and visual acuity. Analysis was done in the intention-to-treat population. This trial is registered with ClinicalTrials.gov number NCT01124838. FINDINGS Between Aug 10, 2010, and May 14, 2015, we randomly assigned 229 patients to receive placebo (n=114) or adalimumab (n=115); 226 patients comprised the intention-to-treat population. Median follow-up time was 155 days (IQR 77-357) in the placebo group and 245 days (119-564) in the adalimumab group. Treatment failure occurred in 61 (55%) of 111 patients in the placebo group compared with 45 (39%) of 115 patients in the adalimumab group. Time to treatment failure was significantly improved in the adalimumab group compared with the placebo group (median not estimated [>18 months] vs 8·3 months; hazard ratio 0·57, 95% CI 0·39-0·84; p=0·004). The 40th percentile for time to treatment failure was 4·8 months in the placebo group and 10·2 months in the adalimumab group. No patients in either group had opportunistic infections (excluding oral candidiasis and tuberculosis). No malignancies were reported in the placebo group whereas one (1%) patient in the adalimumab group reported non-serious squamous cell carcinoma. The most common adverse events were arthralgia (12 [11%] patients in the placebo group and 27 [23%] patients in the adalimumab group), nasopharyngitis (16 [17%] and eight [16%] patients, respectively), and headache (17 [15%] patients in each group). INTERPRETATION Adalimumab significantly lowered the risk of uveitic flare or loss of visual acuity upon corticosteroid withdrawal in patients with inactive, non-infectious intermediate, posterior, or panuveitic uveitis controlled by systemic corticosteroids. No new safety signals were observed and the rate of adverse events was similar between groups. These findings suggest that adalimumab is well tolerated and could be an effective treatment option in this patient population. An open-label extension study (NCT01148225) is ongoing to provide long-term safety data for adalimumab in patients with non-infectious uveitis. FUNDING AbbVie.
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Affiliation(s)
- Quan Dong Nguyen
- Ocular Imaging Research and Reading Center (OIRRC), Omaha, NE, USA.
| | | | | | - Andrew D Dick
- University of Bristol, Bristol Eye Hospital, Bristol, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, London, UK
| | | | - John Sheppard
- Lions Medical Eye Bank of Eastern Virginia, Eastern Virginia Medical School and Virginia Eye Consultants, Norfolk, VA, USA
| | | | - Carlos Pavesio
- Moorfields Eye Hospital and University College London, Institute of Ophthalmology, London, UK
| | - Luca Cimino
- Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia RE, Italy
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Semeraro F, Arcidiacono B, Nascimbeni G, Angi M, Parolini B, Costagliola C. Anti-TNF therapy for juvenile idiopathic arthritis-related uveitis. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:341-8. [PMID: 24711694 PMCID: PMC3969254 DOI: 10.2147/dddt.s54207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Juvenile idiopathic arthritis-related uveitis is the most common type of uveitis in childhood and one of the main causes of visual impairment in children. The introduction of biological treatment has widened the range of therapeutic options for children with uveitis refractory to standard nonbiologic immunosuppressants. Data from clinical trials suggest that both adalimumab and infliximab have demonstrated effectiveness and safety in open-label studies, although no large, randomized, controlled trials have been reported so far. The role of etanercept in treating juvenile idiopathic arthritis-related uveitis is not yet well defined. In our experience, anti-tumor necrosis factor therapy has been shown to be more effective than steroids and/or methotrexate in treating uveitis. Up to now, tumor necrosis factor blocking compounds have been reserved for the treatment of the most severe cases of refractory uveitis, and larger prospective clinical trials are required in order to better assess the safety of these new compounds.
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Affiliation(s)
- Francesco Semeraro
- Eye Clinic, Department of Neurological Sciences and Vision, University of Brescia, Brescia, Italy
| | | | - Giuseppe Nascimbeni
- Eye Clinic, Department of Neurological Sciences and Vision, University of Brescia, Brescia, Italy
| | - Martina Angi
- Eye Clinic, Department of Neurological Sciences and Vision, University of Brescia, Brescia, Italy
| | | | - Ciro Costagliola
- Eye Clinic, Department of Health Sciences, University of Molise, Campobasso, Italy
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Usefulness of adalimumab in the treatment of refractory uveitis associated with juvenile idiopathic arthritis. Mediators Inflamm 2013; 2013:560632. [PMID: 24489444 PMCID: PMC3892756 DOI: 10.1155/2013/560632] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 10/02/2013] [Indexed: 11/17/2022] Open
Abstract
Purpose. To assess the efficacy and safety of adalimumab in patients with juvenile idiopathic arthritis (JIA) and associated refractory uveitis. Design. Multicenter, prospective case series. Methods. Thirty-nine patients (mean [SD] age of 11.5 [7.9] years) with JIA-associated uveitis who were either not responsive to standard immunosuppressive therapy or intolerant to it were enrolled. Patients aged 13–17 years were treated with 40 mg of adalimumab every other week for 6 months and those aged 4–12 years received 24 mg/m2 body surface. Results. Inflammation of the anterior chamber (2.02 [1.16] versus 0.42 [0.62]) and of the posterior segment (2.38 [2.97] versus 0.35 [0.71] decreased significantly between baseline and the final visit (P < 0.001). The mean (SD) macular thickness at baseline was 304.54 (125.03) μ and at the end of follow-up was 230.87 (31.12) μ (P < 0.014). Baseline immunosuppression load was 8.10 (3.99) as compared with 5.08 (3.76) at the final visit (P < 0.001). The mean dose of corticosteroids also decreased from 0.25 (0.43) to 0 (0.02) mg (P < 0.001). No significant side effects requiring discontinuation of therapy were observed. Conclusion. Adalimumab seems to be an effective and safe treatment for JIA-associated refractory uveitis and may reduce steroid requirement.
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Takeuchi M. A systematic review of biologics for the treatment of noninfectious uveitis. Immunotherapy 2013; 5:91-102. [PMID: 23256801 DOI: 10.2217/imt.12.134] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Noninfectious uveitis is a potentially sight-threatening ocular disorder and variable therapeutic strategies have been proposed. Biologic therapies were introduced as a new option for patients with uveitis refractory to the conventional therapy using corticosteroids and immunosuppressive agents, and 10 years have passed since the initiation. In this review, the author summarizes current articles on the assessment of therapeutic application of biologics for refractory uveitis including other autoimmune diseases. Although some results are based on investigation with insufficient clinical trials, especially in biologics, the majority of biologics indicate preferable outcomes on refractory uveitis, with remarkable promise to increase the possibility of long-term remissions.
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Affiliation(s)
- Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, Saitama, Japan.
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Treatment of refractory uveitis with adalimumab: a prospective multicenter study of 131 patients. Ophthalmology 2012; 119:1575-81. [PMID: 22525047 DOI: 10.1016/j.ophtha.2012.02.018] [Citation(s) in RCA: 176] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 02/12/2012] [Accepted: 02/13/2012] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To evaluate adalimumab therapy in refractory uveitis. DESIGN Prospective case series. PARTICIPANTS A total of 131 patients with refractory uveitis and intolerance or failure to respond to prednisone and at least 1 other systemic immunosuppressive drug participated. INTERVENTION Patients received a 40 mg adalimumab subcutaneous injection every other week for 6 months. The associated immunosuppressants were tapered after administering 3 adalimumab injections (week 6). MAIN OUTCOME MEASURES Degree of anterior and posterior chamber inflammation (Standardization of Uveitis Nomenclature Working Group criteria), immunosuppression load (as defined by Nussenblatt et al), visual acuity (logarithm of the minimal angle of resolution [logMAR]), and macular thickness (optical coherence tomography). RESULTS There were 61 men and 70 women (mean age, 27.3 years). The most common causes were juvenile idiopathic arthritis in 39 patients, pars planitis in 16 patients, and Behçet's disease in 13 patients. Twenty-seven patients had uveitis of idiopathic origin. Inflammation in the anterior chamber was present in 82% of patients and in the vitreous cavity in 59% of patients. Anterior chamber inflammation and vitreous inflammation decreased significantly (P < 0.001) from a mean of 1.51 and 1.03 at baseline to 0.25 and 0.14, respectively, at 6 months. Macular thickness was 296 (102) μ at baseline versus 240 (36) μ at the 6-month visit (P < 0.001). Visual acuity improved by -0.3 logMAR in 32 of 150 eyes (21.3%) and worsened by +0.3 logMAR (-15 letters) in 5 eyes (3.3%). The dose of corticosteroids also decreased from 0.74 (3.50) to 0.20 (0.57) mg/kg/day (P < 0.001). Cystoid macular edema, which was present in 40 eyes at baseline, showed complete resolution in 28 eyes at 6 months. The mean suppression load decreased significantly (8.81 [5.05] vs 5.40 [4.43]; P < 0.001). Six months after the initiation of the study, 111 patients (85%) were able to reduce at least 50% of their baseline immunosuppression load. Only 9 patients (6.9%) had severe relapses during the 6 months of follow-up. CONCLUSIONS Adalimumab seems to be well tolerated and helpful in decreasing inflammatory activity in refractory uveitis and may reduce steroid requirement. Further controlled studies of adalimumab for uveitis are warranted.
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Wu L, Fernando Arevalo J, Hernandez-Bogantes E, Roca JA. Intravitreal infliximab for refractory pseudophakic cystoid macular edema: results of the Pan-American Collaborative Retina Study Group. Int Ophthalmol 2012; 32:235-43. [PMID: 22484726 DOI: 10.1007/s10792-012-9559-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 03/23/2012] [Indexed: 10/28/2022]
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Treatment of juvenile idiopathic arthritis-associated uveitis: challenges and update. Curr Opin Rheumatol 2011; 23:432-6. [PMID: 21738033 DOI: 10.1097/bor.0b013e328349c324] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To update the current understanding of the risk factors for poor outcomes in juvenile idiopathic arthritis-related uveitis. In addition, current therapies, both traditional and biological, are reviewed. RECENT FINDINGS Male sex, independent of age or antinuclear antibody status, is associated with increased ocular morbidity. Having anterior chamber inflammation on first exam increases the risk of developing vision-threatening eye complications. Presence of one complication increases the risk of developing another. Risk of cataract development associated with topical glucocorticoid use is better defined. Longer duration of remission on therapy has been found to decrease the risk of disease flare after discontinuation of methotrexate. Recent studies of both nonbiological and biological therapies for arthritis-related uveitis are discussed. SUMMARY With a better understanding of risk factors associated with the ocular morbidity of uveitis associated with juvenile idiopathic arthritis, aggressive therapies can be targeted for improved visual outcomes. Alternative treatments to avoid long-term corticosteroid use include the use of antimetabolites and biological therapies. More prospective comparator studies and/or use of multicenter databases are needed to better understand best treatments.
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Efectividad del etanercept en el tratamiento de la artritis idiopática juvenil. An Pediatr (Barc) 2009; 70:354-61. [DOI: 10.1016/j.anpedi.2008.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 12/11/2008] [Accepted: 12/12/2008] [Indexed: 11/19/2022] Open
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Simonini G, Zannin ME, Caputo R, Falcini F, de Martino M, Zulian F, Cimaz R. Loss of efficacy during long-term infliximab therapy for sight-threatening childhood uveitis. Rheumatology (Oxford) 2008; 47:1510-4. [DOI: 10.1093/rheumatology/ken298] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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