Drug-induced Sarcoid Uveitis with Biologics

Sobolewska, Bianka; Baglivo, Edoardo; Edwards, Albert O.; Kramer, Michal; Miserocchi, Elisabetta; Palestine, Alan G.; Schwab, Ivan R.; Zamir, Ehud; Doycheva, Deshka; Zierhut, Manfred

doi:10.1080/09273948.2020.1850799

Cited by 11 publications

(8 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…129 Paradoxically anti-TNFalpha agents can actually induce a sarcoid-like granulomatous inflammation, the prevalence of which is estimated at 0.04%. 38 Data from clinical trials have shown good effect with adalimumab for non-infectious uveitis leading to significant reduction in risk of treatment failure and achieving steroid-free disease quiescence. 135,136 Infliximab is similar to adalimumab in treatment response and safety.…”

Section: Systemic Treatmentmentioning

confidence: 99%

“…Sarcoidosis refractory to cDMARDs is uncommon and should prompt further investigation for other granulomatous disease mimicking sarcoidosis such as TB, Whipple's disease, granulomatosis with polyangiitis and neoplasms 129 . Paradoxically anti‐TNFalpha agents can actually induce a sarcoid‐like granulomatous inflammation, the prevalence of which is estimated at 0.04% 38 …”

Section: Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Insights into the diagnosis and management of sarcoid uveitis: A review

Samalia,

Lim,

Niederer

2024

Clinical Exper Ophthalmology

View full text Add to dashboard Cite

Sarcoidosis is a leading cause of non‐infectious uveitis that commonly affects middle‐aged individuals and has a female preponderance. The disease demonstrates age, sex and ethnic differences in clinical manifestations. A diagnosis of sarcoidosis is made based on a compatible clinical presentation, supporting investigations and histologic evidence of non‐caseating granulomas, although biopsy is not always possible. Multimodal imaging with widefield fundus photography, optical coherence tomography and angiography can help in the diagnosis of sarcoid uveitis and in the monitoring of treatment response. Corticosteroid remains the mainstay of treatment; chronic inflammation requires steroid‐sparing immunosuppression. Features on multimodal imaging such as vascular leakage may provide prognostic indicators of outcome. Female gender, prolonged and severe uveitis, and posterior involving uveitis are associated with poorer visual outcomes.

show abstract

Section: Systemic Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Insights into the diagnosis and management of sarcoid uveitis: A review

Samalia,

Lim,

Niederer

2024

Clinical Exper Ophthalmology

View full text Add to dashboard Cite

show abstract

“…Ocular manifestations of sarcoidosis, isolated or accompanied by the involvement of other organs, have been detected in several patients [67][68][69][70][71][72][73][74][75][76][77][78][79][80], as summarized in Table 4. Of particular interest are the cases, independently reported, of two female RA patients (54-and 59-years-old) who developed sarcoid-like disease during etanercept treatment.…”

Section: Ocular Adr To Tnfismentioning

confidence: 99%

“…Etanercept was withdrawn and the patient was treated with GCs in addition to MTX and infliximab, with clinical improvement [ 76 ] F, 54 Etanercept (6) Bilateral iritis with congestion of the bulbar conjunctiva Lymph node biopsy consistent with sarcoidosis. After etanercept treatment was stopped, a follow-up examination showed improvement without therapeutic intervention [ 77 ] F, 68 Etanercept (72) Unilateral anterior uveitis Etanercept was maintained and resolution was achieved with topical GCs [ 77 ] M, 71 Infliximab (undefined) Unilateral uveitis with massive granulomatous keratic precipitates Infliximab was discontinued. Certolizumab, oral GCs, and MTX induced complete recovery [ 78 ] F, 40 Etanercept (32) Bilateral acute anterior uveitis Steroid drops yielded a favorable response.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Natural and iatrogenic ocular manifestations of rheumatoid arthritis: a systematic review

et al. 2021

View full text Add to dashboard Cite

Purpose To provide an overview of the ocular features of rheumatoid arthritis (RA) and of the ophthalmic adverse drug reactions (ADRs) that may be associated with the administration of antirheumatic drugs. Methods A systematic literature search was performed using the PubMed, MEDLINE, and EMBASE databases. In addition, a cohort of 489 RA patients who attended the Authors’ departments were examined. Results Keratoconjunctivitis sicca, episcleritis, scleritis, peripheral ulcerative keratitis (PUK), and anterior uveitis were diagnosed in 29%, 6%, 5%, 2%, and 10%, respectively, of the mentioned cohort. Ocular ADRs to non-steroidal anti-inflammatory drugs are rarely reported and include subconjunctival hemorrhages and hemorrhagic retinopathy. In patients taking indomethacin, whorl-like corneal deposits and pigmentary retinopathy have been observed. Glucocorticoids are frequently responsible for posterior subcapsular cataracts and open-angle glaucoma. Methotrexate, the prototype of disease-modifying antirheumatic drugs (DMARDs), has been associated with the onset of ischemic optic neuropathy, retinal cotton-wool spots, and orbital non-Hodgkin’s lymphoma. Mild cystoid macular edema and punctate keratitis in patients treated with leflunomide have been occasionally reported. The most frequently occurring ADR of hydroxychloroquine is vortex keratopathy, which may progress to “bull’s eye” maculopathy. Patients taking tofacitinib, a synthetic DMARD, more frequently suffer herpes zoster virus (HZV) reactivation, including ophthalmic HZ. Tumor necrosis factor inhibitors have been associated with the paradoxical onset or recurrence of uveitis or sarcoidosis, as well as optic neuritis, demyelinating optic neuropathy, chiasmopathy, and oculomotor palsy. Recurrent episodes of PUK, multiple cotton-wool spots, and retinal hemorrhages have occasionally been reported in patients given tocilizumab, that may also be associated with HZV reactivation, possibly involving the eye. Finally, rituximab, an anti-CD20 monoclonal antibody, has rarely been associated with necrotizing scleritis, macular edema, and visual impairment. Conclusion The level of evidence for most of the drug reactions described herein is restricted to the “likely” or “possible” rather than to the “certain” category. However, the lack of biomarkers indicative of the potential risk of ocular ADRs hinders their prevention and emphasizes the need for an accurate risk vs. benefit assessment of these therapies for each patient.

show abstract

Multiple drugs

2022

Reactions Weekly

View full text Add to dashboard Cite

Drug-induced Sarcoid Uveitis with Biologics

Cited by 11 publications

References 34 publications

Insights into the diagnosis and management of sarcoid uveitis: A review

Insights into the diagnosis and management of sarcoid uveitis: A review

Natural and iatrogenic ocular manifestations of rheumatoid arthritis: a systematic review

Multiple drugs

Contact Info

Product

Resources

About