Cyclosporine vs Tacrolimus Therapy for Posterior and Intermediate Uveitis

Murphy, Conor C; Greiner, Kathrin; Plskova, Jarka; Duncan, Linda; Frost, N A; Forrester, John V.; Dick, Andrew D.

doi:10.1001/archopht.123.5.634

Cited by 149 publications

(77 citation statements)

References 26 publications

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“…Details of the excluded full-text articles with reasons for exclusion are presented in Appendix 2. Seventeen potentially relevant articles (relating to 16 studies) were retained for potential inclusion in meta-analyses; 13 studies 32,33,[57][58][59][60][61][62][63][64][65][66][67] were related to comparators within the scope of the review and three studies (four articles [46][47][48]68 ) evaluated ADA or DEX 700. It was not possible to include any of the 13 studies of comparators within a NMA (the reasons why this was not possible, and a summary of the 13 studies, are provided in Indirect comparison of treatments: rationale for not undertaking and Table 24).…”

Section: Results Of the Clinical Effectiveness Reviewmentioning

confidence: 99%

See 1 more Smart Citation

A systematic review and economic evaluation of adalimumab and dexamethasone for treating non-infectious intermediate uveitis, posterior uveitis or panuveitis in adults

Squires

Poku

Bermejo

et al. 2017

Health Technol Assess

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Declared competing interests of authors: Fahd Quhill has received personal fees from Allergan for participation in medical education and training, and has participated in advisory boards given his clinical expertise in the role of steroids in diabetic macular oedema. He has also received support from Allergan to attend international conferences.Published November 2017 DOI: 10.3310/hta21680 This report should be referenced as follows: This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: journals.library@nihr.ac.ukThe full HTA archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hta. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Technology Assessment journalReports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hta This reportThe research reported in this issue of the journal was commissioned and funded by the HTA programme on behalf of NICE as project number 15/64/07. The protocol was agreed in June 2016. The assessment report began editorial review in December 2016 and was accepted for publication in May 2017. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expre...

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Section: Results Of the Clinical Effectiveness Reviewmentioning

confidence: 99%

“…31 The most common AEs associated with immunosuppressants include cataracts, ocular hypertension, headache, fever, nausea, diarrhoea, fatigue, paraesthesia, tremors and systemic infection. 32,33 These can lead to substantial reductions in HRQoL for the patient and may also have an impact on the patient's family.…”

Section: Impact Of the Health Problemmentioning

confidence: 99%

A systematic review and economic evaluation of adalimumab and dexamethasone for treating non-infectious intermediate uveitis, posterior uveitis or panuveitis in adults

Squires

Poku

Bermejo

et al. 2017

Health Technol Assess

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“…Over the last few years, assisted by major expert opinion overview articles that provided treatment recommendations, 49 there have been further seminal trials and patient cohort studies highlighting the evidence for treatment with non-biologic conventional immunosuppressants. 4,7,[50][51][52][53][54][55][56][57][58] The most compelling studies of recent years include evidence from patient cohort analytical studies for the use of cellcept displaying its effectiveness as a corticosteroid-sparing agent with an acceptable adverse event profile. 4,7,59 In particular, there are two studies that presented their results in accordance with SUN guidelines showing concordance in effect, with around an 80% chance of achieving disease control at a prednisolone dose of o10 mg/day.…”

Section: Treatment Outcomes To Datementioning

confidence: 99%

“…A small RCT of tacrolimus vs CsA showed that the treatment effect over a 6-month period was similar, as was quality-of-life, but CsA therapy was associated with a higher incidence of elevated blood pressure and cholesterol. 55 A cohort analysis of 62 patients has since revealed that patients on tacrolimus had an 85% probability of achieving remission and o10 mg/day of prednisolone with an excellent cardiovascular risk profile. 58 The efficacy of voclosporin has also since been assessed in the international Lux Uveitis Multicenter Investigation of a New Approach to Treatment (LUMINATE) studies.…”

Section: Treatment Outcomes To Datementioning

confidence: 99%

Current concepts and future directions in the pathogenesis and treatment of non-infectious intraocular inflammation

Lee

Dick

2011

Eye

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The blockbuster drug paradigm is under increasing scrutiny across the biopharmaceutical industry. Intraocular inflammation poses particular challenges to this, given the heterogeneity of conditions in the uveitis spectrum, and the increasing acknowledgement of individual patient and disease variance in underlying immune responses. This need has triggered a drive towards personalised and stratified medicine, supported and enabled as a result of continued development of both experimental models and molecular biological techniques and improved clinical classification. As such we have the ability now to systematically appraise at a genomic, transcriptomic, and proteomic level individual immunophenotype, and the promise that in the eye this can be augmented by in vivo immune imaging to identify individual immunopathology. With such advances all running in parallel, we are entering an era of experimental medicine that will facilitate early diagnosis, generate biomarkers for accurate prognostication, and enable the development of individualised and targeted therapies, which can progress rapidly into clinical practice.

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“…A decade later, another study examined the effects of low-dose tacrolimus in a small cohort of patients with endogenous posterior uveitis who had failed cyclosporine therapy and found that visual improvement was achieved for 3 months or more with a mean maintenance dose of 0.06 AE 0.02 mg/kg/day without development of nephrotoxicity, the primary reason for discontinuing cyclosporine A therapy (Kilmartin et al 1998a). More recently, a randomized trial of tacrolimus versus cyclosporine in the treatment of posterior and intermediate uveitis also demonstrated similar efficacy with improved safety profile in tacrolimus versus cyclosporine (Murphy et al 2005). Despite its improved safety profile, tacrolimus is associated with several adverse effects similar to cyclosporine, including nephrotoxicity, neurotoxicity, hypertension, gastrointestinal disturbances, infections, and malignancy (Barbarino et al 2013).…”

Section: Tacrolimusmentioning

confidence: 99%