A Review of the Course and Treatment of Non-Infectious Uveitis during Pregnancy

Grotting, Lindsay; Papaliodis, George N.

doi:10.1080/08820538.2016.1228402

Cited by 14 publications

(11 citation statements)

References 61 publications

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“…This is followed by an increased relapse rate in the first months postpartum, coinciding with the rapid decrease in pregnancy hormone levels. A similar effect is also observed for other autoimmune diseases such as rheumatoid arthritis (RA) and uveitis (3). The reduction in MS disease activity during pregnancy is thought to be caused by a shift towards a more immune tolerant and anti-inflammatory state which allows the immune interactions at the feto-maternal interphase needed for a successful pregnancy (4).…”

Section: Introductionmentioning

confidence: 70%

Pregnancy-Induced Changes in microRNA Expression in Multiple Sclerosis

et al. 2021

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Pregnancy affects the disease course in multiple sclerosis (MS), particularly in the third trimester, where the relapse rate is reduced by as much as two thirds. This study aimed at identifying changes in microRNA (miRNA) and immune cell phenotypes in pregnant MS patients. Discovery and validation studies to detect differentially expressed miRNAs were performed with quantitative real-time PCR on peripheral blood mononuclear cells (PBMC). Flow cytometry analysis was performed on PBMC stained with antibodies directed against surface markers of antigen presenting cells (APCs), NK-cells, NKT cells, CD4+ and CD8+ T cells and subsets of these cell types, including PDL1 and PDL2 expressing subsets. RNA was extracted from whole blood, monocytes, and NK-cells to investigate expression and correlation between regulated miRNAs and mRNAs. In total, 15 miRNAs were validated to be differentially expressed between third trimester pregnant and postpartum MS patients (Benjamini-Hochberg false discovery rate from p = 0.03–0.00004). Of these, 12 miRNAs were downregulated in pregnancy and 6 of the 15 miRNAs were altered by more than ±2-fold (+2.99- to -6.38-fold). Pregnant MS patients had a highly significant increase in the percentage of monocytes and a decrease of NK-cells and myeloid dendritic cells compared to non-pregnant MS patients. We confirm previous reports of a relative increase in CD56-bright NK-cells and a decrease in CD56-dim NK-cells in third trimester of pregnancy and report an increase in non-committed follicular helper cells. PDL1 and PDL2 expression was increased in pregnant patients together with IL10. Also, in monocytes IL10, PDL1, and PDL2 were upregulated whereas miR-1, miR-20a, miR-28, miR-95, miR-146a, miR-335, and miR-625 were downregulated between pregnant and untreated MS patients. IL10, PDL1, and PDL2 were predicted targets of MS pregnancy-changed miRNAs, further supported by their negative correlations. Additionally, previously identified pregnancy-regulated mRNAs were identified as predicted targets of the miRNAs. PDL1 and PDL2 bind PD-1 expressed on T cells with an inhibitory effect on T-cell proliferation and increase in IL10 production. These results indicate that some of the effects behind the disease-ameliorating third trimester of pregnancy might be caused by changed expression of miRNAs and immunoregulatory molecules in monocytes.

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Section: Introductionmentioning

confidence: 70%

Pregnancy-Induced Changes in microRNA Expression in Multiple Sclerosis

et al. 2021

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“…In our series, six infants were successfully breastfed. At the time of making a decision about therapy during pregnancy in patients with uveitis, it is necessary to consider the possible harmful effects of some agents (13,14). Due to this, we also reviewed the compatibility of the common immunosuppressive drugs used in uveitis with pregnancy and breastfeeding (Table IV).…”

Section: Discussionmentioning

confidence: 99%

“…Available evidence suggests that there is an initial increase in uveitis activity at pregnancy onset that progressively decreases to the lowest activity in the third trimester. However, the postpartum period has been associated with a rebound of flare rates (9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

“…According to most authors, it is recommended the addition of conventional diseasemodifying anti-rheumatic drugs (cD-MARDs) when high doses of systemic glucocorticoids are needed to control the ocular inflammation. However, it is important to avoid methotrexate, mycophenolate mofetil, leflunomide and cyclophosphamide (4,(13)(14)(15). Biologic therapy should be considered when conventional therapy fails.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of certolizumab pegol in pregnant women with uveitis. Recommendations on the management with immunosuppressive and biologic therapies in uveitis during pregnancy

Prieto-Peña

Calderón-Goercke

Adán

et al. 2021

Clinical and Experimental Rheumatology

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ObjectiveClinicians often face the challenge of providing effective and safe therapy for pregnant women with uveitis. Certolizumab pegol (CZP) differs from other anti-TNFα agents due to its limited placental transfer. In this study we assessed the efficacy of CZP in pregnant women with uveitis. We also provided information on outcomes of pregnant women and neonates exposed to CZP. MethodsWe carried out a multicentre study of women with uveitis who received CZP during pregnancy and their neonates.The main visual outcomes were visual acuity (VA), intraocular inflammation and corticosteroid-sparing effect. Pregnancy outcomes, maternal and neonatal infections and congenital malformations were also assessed. ResultsWe studied 14 women (23 affected eyes); mean age of 34.3±5.5 years. The underlying diseases were spondyloarthritis (n=7), idiopathic (n=2), and Vogt-Koyanagi-Harada, rheumatoid arthritis, juvenile idiopathic arthritis, punctate inner choroidopathy and Behçet's disease (1 each). The patterns of ocular involvement were anterior (n=10), posterior (n=2), intermediate (n=1), panuveitis (n=1). Cystoid macular oedema was present in one patient (1 eye). Uveitis was bilateral in nine cases and chronic in seven patients. CZP was started before getting pregnant in ten patients and after conceiving in four. All patients achieved or maintained ocular remission throughout pregnancy. Fifteen healthy infants were born. Only one woman presented a mild infection during pregnancy. Neither infections nor malformations were observed in neonates after a follow-up of 6 months. Six infants were breastfed and all of them received scheduled vaccinations without complications. ConclusionCertolizumab pegol is effective and safe in women with uveitis during pregnancy.

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“…Pregnancy is well known to be associated with numeral immunological and hormonal changes, favouring the maternal tolerance of the fetus (Chiam & Lim 2014;Grotting & Papaliodis 2017). Most studies regarding noninfectious uveitis demonstrate a decline of disease activity during the second and third trimester of pregnancy with an increase in the relapse rate within the first 6 months postpartum to the prepregnancy situation (Rabiah & Vitale 2003;Kump et al 2006;Chiam et al 2013;Verhagen et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Idiopathic multifocal choroiditis and punctate inner choroidopathy: an evaluation in pregnancy

Groot

Huet

Bloemenkamp

et al. 2021

Acta Ophthalmologica

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Purpose To evaluate the clinical course of idiopathic multifocal choroiditis (MFC) and punctate inner choroidopathy (PIC) and the efficacy and safety of treatment options during pregnancy. Methods Patients with MFC or PIC and a pregnancy in 2011–2019 from two academic centres were enrolled. For the most recent pregnancy, data on best‐corrected visual acuity (BCVA) before and after pregnancy, relapse rate in pregnancy and postpartum period and obstetric, maternal and neonatal outcomes were collected. Treatment regimens consisted of a wait‐and‐see regime and an immunosuppressive treatment regime with systemic corticosteroids and/or azathioprine, both combined with intravitreal antivascular endothelial growth factor injections when indicated. Results Sixteen women (26 affected eyes) were included. Median Snellen BCVA was 20/19 before pregnancy and 20/18 after delivery. In seven pregnancies a wait‐and‐see regime and in nine pregnancies an immunosuppressive treatment regime was carried out. Fourteen intravitreal anti‐VEGF injections were given in six pregnancies. The relapse rate during pregnancy was 44% and in the postpartum period 31%. Maternal/obstetrical and fetal complications occurred in 31% and 13% of the pregnancies, respectively. Fifteen healthy children were born and one pregnancy ended in a stillbirth in a patient with a complicated obstetrical history. One patient treated with azathioprine developed intrahepatic cholestasis of pregnancy (ICP). Conclusions Among women with MFC and PIC BCVA remained stable during pregnancy despite a relapse rate of 44% in pregnancy. No major maternal, obstetric and fetal complications occurred in pregnant patients treated with systemic corticosteroids, azathioprine or intravitreal anti‐VEGF injections, though one patient developed ICP while treated with azathioprine.

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A Review of the Course and Treatment of Non-Infectious Uveitis during Pregnancy

Cited by 14 publications

References 61 publications

Pregnancy-Induced Changes in microRNA Expression in Multiple Sclerosis

Pregnancy-Induced Changes in microRNA Expression in Multiple Sclerosis

Efficacy and safety of certolizumab pegol in pregnant women with uveitis. Recommendations on the management with immunosuppressive and biologic therapies in uveitis during pregnancy

Idiopathic multifocal choroiditis and punctate inner choroidopathy: an evaluation in pregnancy

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