An update on the use of biologic therapies in the management of uveitis in Behçet’s disease: a comprehensive review

McNally, Thomas W.; Damato, Erika M.; Murray, Philip I.; Denniston, Alastair K; Barry, Robert J.

doi:10.1186/s13023-017-0681-6

Cited by 24 publications

(24 citation statements)

References 98 publications

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“…Although the remaining anti-TNF therapies are considered off-label for uveitis, they are still used to control ocular inflammation associated with systemic diseases [21,22] and are specially effective in Behçet's disease [23,24] and juvenile idiopathic arthritis [25]. Experience with golimumab [26] and certolizumab [27] to treat ocular inflammatory disease is limited but encouraging.…”

Section: Anti-tnf Therapy In Ophthalmologymentioning

confidence: 99%

A review of ocular adverse events of biological anti-TNF drugs

Susanna

Pavésio

2020

J Ophthal Inflamm Infect

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The recent introduction of biological agents has revolutionized the treatment of chronic immune-inflammatory diseases; however, this new therapy did not come without significant side effects. Through large controlled studies indicating decrease in the number of uveitis flares, the role of TNF inhibitors therapy for non-infectious uveitis gained more ground. Paradoxically to its therapeutic effect, there are reports associating these drugs with the onset or recurrence of inflammatory eye disease. A number of studies have suggested possible roles for anti-TNF-α agents in precipitating or worsening an underlying inflammatory process, including the hypothesis of a disequilibrium in cytokine balance, but to date the mechanisms responsible for these adverse events are not fully understood. A PubMed literature search was performed using the following terms: ophthalmic complication, uveitis, inflammatory eye disease, optic neuritis, neuropathy, adverse events, anti-TNF, TNF alpha inhibitor, infliximab, etanercept, adalimumab, golimumab, certolizumab, and biologics. The data presented in this study was mainly derived from the use of TNF inhibitors in rheumatology, essentially because these drugs have been used for a longer period in this medical field. Many of the ocular adverse events reported on this review may be considered a paradoxical effect of anti-TNF therapy. We found a variety of data associating new onset of uveitis with anti-TNF therapy for rheumatic conditions, predominantly under etanercept. In conclusion, although there is increasing data on ocular adverse events, it remains to be seen whether the suggested link between TNF inhibitors and the onset of ocular inflammation is substantiated by more quality data. Nevertheless, the awareness of potential treatment side effects with anti-TNF should be highlighted.

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Section: Anti-tnf Therapy In Ophthalmologymentioning

confidence: 99%

A review of ocular adverse events of biological anti-TNF drugs

Susanna

Pavésio

2020

J Ophthal Inflamm Infect

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“…Corticosteroids are the mainstay for all clinical features. 26 They are beneficial Lessons of the month in the acute manifestations of BD, but there is no definite evidence in the effectiveness in controlling disease progression. Importantly, adverse effects of long-term therapy with corticosteroids must be considered.…”

Section: Managementmentioning

confidence: 99%

Lessons of the month 2: A case of Behçet’s disease: 70% have ophthalmic involvement

2019

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A 34-year-old man presented to the emergency department with acute painless loss of vision of the left eye. Past medical history included painful lumps in the legs and frequent mouth ulcers, which were undiagnosed. The patient's visual acuity was 6/5 and counting fingers in the right and left eye, respectively. There were extensive intraretinal haemorrhages and venous sheathing in the superior quadrant of the left eye with associated disc oedema. The case was discussed in a multidisciplinary team meeting in the presence of ophthalmology, dermatology and immunology and a diagnosis of Behçet's disease was reached. The patient was commenced on intravenous methylprednisolone for 3 days followed by a switch to oral prednisolone. Due to recalcitrant uveitis, an intravitreal dexamethasone implant was administered. Eventually, systemic azathioprine and infliximab were commenced with frequent review by ophthalmology and immunology. The macular oedema improved but, unfortunately, the patient's visual acuity did not recover. Behçet's disease is a complex vasculitis involving multiple organ systems. Ocular manifestations can occur in 70% of patients, comprising retinal vasculitis, anterior uveitis, iridocyclitis, chorioretinitis, scleritis, keratitis, vitreous haemorrhage, optic neuritis, conjunctivitis, retinal vein occlusion and retinal neovascularisation. A tailored multidisciplinary approach is required, with corticosteroids being the mainstay of treatment.

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“…[57][58] Authors have reported its effectiveness in the management of severe uveitic cases. 7,[57][58][59][60][61][62][63][64][65] Interleukin (IL)-1 has shown to be a key proinflammatory cytokine in many autoimmune diseases and its inhibition might have a promising future among other novel therapeutic opportunities. 58…”

Section: Fusion Protein Of Ctla-4mentioning

confidence: 99%

“…6 Long-term use of corticosteroids produced toxic effects both locally and systemically. 6,7 Corticosteroid-sparing immunomodulatory treatments were subsequently introduced to avoid such side effects. However, these therapies did not lead to suffice outcomes in some active uveitis cases or in the management of adverse effects.…”

Section: Introductıonmentioning

confidence: 99%

“…8 In order to circumvent this limitation, a new choice of drug named 'biologics' has been derived from living microorganisms, plants or animal cells. 7 These agents target immune and inflammatory pathways at the cellular level thereby suppressing immune response and preventing further structural damage. 9 Based on the target receptor, biologics can be classified into the following categories (Table 1): 1.…”

Section: Introductıonmentioning

confidence: 99%

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Biologics in uveitis: An update

Magesan

Shah²,

Biswas³

2019

IJIR

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Uveitis is' the term used to describe inflammation of the uvea. It can be due to infective or non-infective agents. Most of the non-infectious uveitides are autoimmune or auto-inflammatory in nature, and the management of non-infective uveitis is often crucial. Advancements in biotechnology and understanding the pathophysiologies of autoimmune diseases have enabled the development of the new class of drugs named 'biologics'. These drugs act at cellular level inhibiting the actions of pro-inflammatory cytokines including tumor necrosis factor-α (TNF-α), interleukin-1, and IL-6, and B and T lymphocytes. Biologics have been proven to be less toxic and can be used in uveitic cases that are refractory to conventional therapy. Though the efficacy of biologics is based on insufficient clinical trials, majority of them indicate preferable outcomes on refractory uveitis, with remarkable promise to increase the possibility of long-term remission. In this review, we aimed to outline the ideal characteristics of each biologic drug and review the data to support the use of current and emerging biological therapies.

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An update on the use of biologic therapies in the management of uveitis in Behçet’s disease: a comprehensive review

Cited by 24 publications

References 98 publications

A review of ocular adverse events of biological anti-TNF drugs

A review of ocular adverse events of biological anti-TNF drugs

Lessons of the month 2: A case of Behçet’s disease: 70% have ophthalmic involvement

Biologics in uveitis: An update

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