Biological response modifier therapy for refractory childhood uveitis

Gallagher, Michael J.; Quinones, K.; Cervantes-Castañeda, René A.; Yilmaz, Taygan; Foster, C. Stephen

doi:10.1136/bjo.2007.124081

Cited by 97 publications

(57 citation statements)

References 19 publications

(18 reference statements)

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“…Different strategies, ranging from 24 mg/m 2 every 2 weeks up to 40 mg/m 2 weekly (8,9,11,19,22), were reported for ADA therapy. Children received INF at doses ranging from 3 mg/kg up to 20 mg/kg at variable intervals between 2 and 8 weeks; 1 study reported only the cumulative dose at each infusion, ranging from 100 -700 mg (9).…”

Section: Resultsmentioning

confidence: 99%

“…Among studies of ETA, only Cantarini et al reported remission information; all 4 children with Behçet's disease treated obtained uveitis remission in a few weeks, with a followup period up to 1 year (16). Regarding ADA, 20 of 25 children obtained remission over a median time of 12 weeks (range 2-12 weeks), with a median followup of 32 weeks (range 4 -40 weeks) (8,9,19,22) children receiving ADA (8,9,11,19,22), and 96 of 114 children receiving INF (8,9,12,13,17,18,21,(23)(24)(25)27,28). According to extractable data from 17 of 23 articles, discontinuation/tapering of concomitant DMARD therapy was possible for 4 of 22 children receiving ETA (29,30), 8 of 12 children receiving ADA (11,22), and 25 of 41 children receiving INF in addition to DMARDs (13,17,18,20,21,(23)(24)(25)27).…”

mentioning

confidence: 99%

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Current Evidence of Anti–Tumor Necrosis Factor α Treatment Efficacy in Childhood Chronic Uveitis: A Systematic Review and Meta‐Analysis Approach of Individual Drugs

Simonini

Druce

Cimaz

et al. 2014

Arthritis Care & Research

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Objective. To summarize evidence regarding the effectiveness of anti-tumor necrosis factor ␣ (anti-TNF␣) treatments in childhood autoimmune chronic uveitis (ACU), refractory to previous disease-modifying antirheumatic drugs (DMARDs). Methods. A systematic search between January 2000 and October 2012 was conducted using EMBase, Ovid Medline, Evidence-Based Medicine (EBM) Reviews: American College of Physicians Journal Club, Cochrane libraries, and EBM Reviews. Studies investigating the efficacy of anti-TNF␣ therapy, in children ages <16 years, as the first treatment with a biologic agent for ACU, refractory to topical and/or systemic steroid therapy and at least 1 DMARD, were eligible for inclusion. The primary outcome measure was the improvement of intraocular inflammation, as defined by the Standardization of Uveitis Nomenclature Working Group criteria. We determined a combined estimate of the proportion of children responding to anti-TNF␣ treatment, including etanercept (ETA), infliximab (INF), or adalimumab (ADA). Results. We initially identified 989 articles, of which 148 were potentially eligible. In total, 22 retrospective chart reviews and 1 randomized clinical trial were deemed eligible, thus including 229 children (ADA: n ‫؍‬ 31, ETA: n ‫؍‬ 54, and INF: n ‫؍‬ 144). On pooled analysis of observational studies, the proportion of responding children was 87% (95% confidence interval [95% CI] 75-98%) for ADA, 72% (95% CI 64 -79%) for INF, and 33% (95% CI 19 -47%) for ETA. There was no difference in the proportion of responders between ADA and INF ( 2 ‫؍‬ 3.06, P ‫؍‬ 0.08), although both showed superior efficacy compared with ETA (ADA versus ETA: 2 ‫؍‬ 20.9, P < 0.001 and INF versus ETA: 2 ‫؍‬ 20.9, P < 0.001). Conclusion. Although randomized controlled trials are needed, the available evidence suggests that INF and ADA provide proven similar benefits in the treatment of childhood ACU, and they are both superior to ETA.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Current Evidence of Anti–Tumor Necrosis Factor α Treatment Efficacy in Childhood Chronic Uveitis: A Systematic Review and Meta‐Analysis Approach of Individual Drugs

Simonini

Druce

Cimaz

et al. 2014

Arthritis Care & Research

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“…Aggressive immunomodulatory therapy is often introduced to improve the visual prognosis and to reduce corticosteroid associated adverse events. With the advent of biologic agents, tumor necrosis factor α (TNFα) antagonists have been successfully used and have changed and markedly improved the treatment options for JIA [35][36][37]. However, a subset of patients fails to respond to TNFα blockers or is unable to tolerate these therapies and may benefit from switching to another drug.…”

Section: Children With Juvenile Idiopathic Arthritis Associated Uveitmentioning

confidence: 99%

Anti-CD 20 monoclonal antibody (rituximab) treatment for inflammatory ocular diseases

Miserocchi¹,

Pontikaki

Modorati³

et al. 2011

Autoimmunity Reviews

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“…[29][30][31] Vogt-Kayanagi-Harada (VGH) hastal›¤›, JIA, sklerit, ankilozan spondilit, psoriazis gibi çok farkl› etyolojilere ba¤l› intraoküler inflamasyonlar›n infliksimab ile kontrol edilebildi¤i bildirilmifltir. [32][33][34][35][36][37] Ayr›ca farkl› endikasyonlarla non-enfektif intraoküler inflamasyonu bulunan olgularda ilac›n intravitreal uyguland›¤›nda makula öde-minde ve görme keskinli¤i üzerine anlaml› olumlu etkisi oldu¤u gösterilmifltir. 38 Ancak diabetik makula öde-mi veya yafla ba¤l› makula dejeneresans› olgular›nda intravitreal infliksimab enjeksiyonunun iyi tolere edilemedi¤i ve retinaya toksik etkisinin oldu¤u bildirilmifltir.…”

Section: Tnf Antagonistleriunclassified

“…45 Adalimumab ile Behçet hastal›¤› d›fl›nda psoriazis, JIA, ankilozan spondilit gibi farkl› endikasyonlarda intraoküler inflamasyonun baflar› ile kontrol edilebildi¤i bildirilmifltir. 35,36,47,48 Biester ve ark. 49 çocukluk ça¤› üveitlerinde yapt›klar› bir çal›flmada, 17'sinde JIA, birinde ise idiopatik üveit bulunan 18 olguluk serilerinde adalimumab ile üveitin tamamen kontrol alt›na al›nma s›kl›¤›n› %88,8 (16/18) bildirmifllerdir.…”

Section: Tnf Antagonistleriunclassified

New Treatment Alternatives in the Management of Non-İnfectious İntraocular İnflammations: Biologic Agents

Emre¹,

Tutkun²

2011

tjo

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ÖzetEnfeksiyöz olmayan üveitlerin tedavisinde son y›llara kadar genel olarak immün sistemi bask›layan ilaçlar kullan›lmak-tayd›. Ancak gen mühendisli¤indeki geliflmeler, inflamatuar süreçte yer alan özgün molekülleri hedefleyen proteinlerin sentezini ve bu proteinlerin terapötik olarak kullan›lmalar›n› mümkün k›lm›flt›r. Genel olarak protein yap›s›ndaki bu ajanlar biyolojik ajanlar olarak adland›r›lm›fllard›r. Oftalmologlar›n biyolojik ajanlar ile tecrübeleri s›n›rl› olsa da, bu ajanlar romatoloji ve dermatoloji baflta olmak üzere di¤er disiplinler taraf›ndan yo¤un biçimde kullan›lmaktad›rlar. ‹nterferon, infliksimab ve adalimumab baflta olmak üzere birçok biyolojik ajan›n üveit hastalar›nda kullan›m› ile ilgili literatür verisi olmas›na ra¤men henüz bu endikasyonda ruhsatl› kullan›mlar› yoktur. Ayr›ca bu ajanlar›n kullan›m› s›ras›nda dikkat edilmesi gereken güvenlik önlemleri ve önemli risk faktörleri mevcuttur. Bu derlemenin amac›, dirençli üveit hastalar›nda kullan›labilen biyolojik ajanlar konusunda güncel ve kapsaml› bilgi sunmakt›r. ( SummaryConventional immunosuppressive agents have been traditionally used for the treatment of noninfectious uveitis. Recent developments in genetic engineering have made it possible to synthesize proteins that target specific molecules playing role in the inflammatory response. These agents are generally in protein structure and are named biologic agents. While there is limited experience with biologics in the field of ophthalmology, they are commonly used in other disciplines such as rheumatology and dermatology. Although considerable data have accumulated in the uveitis literature regarding the use of biologic agents, including mainly interferon, infliximab, and adalimumab, their use for this indication is still off-label. Moreover, there are certain precautions that have to be taken into account, as well as important safety issues associated with their use. The purpose of this paper is to present an updated comprehensive review of biologic agents that may be used for the treatment of refractory uveitis. (Turk J Ophthalmol 2011; 41: 243-55 GiriflEnfeksiyöz olmayan üveitlerin tedavisinde kullan›lmakta olan immunsupresan ajanlar, ba¤›fl›kl›k sistemini genel olarak bask›lamakta veya sapt›rmaktad›rlar. Bu tedavi yöntem-lerinin sebep olduklar› ciddi yan etkiler ile tedaviye dirençli olgular, hekimleri yeni tedavi aray›fllar›na itmektedir. Son y›llarda araflt›r›lan biyolojik ajanlar, inflamatuar süreçteki öz-gün molekülleri (proteinleri) etkileyerek ba¤›fl›kl›k sisteminde daha s›n›rl› ancak etkin bir tedavi sa¤lamaktad›rlar. Biyolojik ajanlar, moleküler rekombinant DNA teknolojisi kullan›larak elde edilen proteinlerdir. Bu ajanlar›n büyük ço¤un-lu¤u monoklonal antikorlard›r. fiu an için enfeksiyöz olmayan üveitlerin tedavisinde bafll›ca kullan›lan biyolojik ajanlar 3 grupta s›n›fland›r›labilir; i. Interferon-α, ii. TNF-α antagonistleri ve iii. Çeflitli sitokin veya yüzey membran proteini gibi farkl› hedeflere yönelik antikorlar veya füzyon proteinleri.

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Biological response modifier therapy for refractory childhood uveitis

Cited by 97 publications

References 19 publications

Current Evidence of Anti–Tumor Necrosis Factor α Treatment Efficacy in Childhood Chronic Uveitis: A Systematic Review and Meta‐Analysis Approach of Individual Drugs

Current Evidence of Anti–Tumor Necrosis Factor α Treatment Efficacy in Childhood Chronic Uveitis: A Systematic Review and Meta‐Analysis Approach of Individual Drugs

Anti-CD 20 monoclonal antibody (rituximab) treatment for inflammatory ocular diseases

New Treatment Alternatives in the Management of Non-İnfectious İntraocular İnflammations: Biologic Agents

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