Intraocular Methotrexate in the Treatment of Uveitis and Uveitic Cystoid Macular Edema

Taylor, Simon; Habot‐Wilner, Zohar; Pacheco, Patricio; Lightman, Sue

doi:10.1016/j.ophtha.2008.10.033

Cited by 111 publications

(74 citation statements)

References 23 publications

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“…14,15 Previous studies have reported potent antiinflammatory properties of the intravitreal MTX in patients with noninfectious uveitis. 16,17 Moreover, intravitreal injection of MTX has less complication compared with the triamcinolone acetonide, another potent widely used anti-inflammatory agent. 9 Two studies reported the use of intra-silicone MTX for surgical indications other than intraocular lymphoma.…”

Section: Discussionmentioning

confidence: 99%

Intra-silicone oil injection of methotrexate at the end of vitrectomy for advanced proliferative diabetic retinopathy

Falavarjani

Modarres

Hadavandkhani

et al. 2015

Eye

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Purpose To evaluate the role of methotrexate (MTX) injected into the silicone oil at the end of pars plana vitrectomy for advanced proliferative diabetic retinopathy (PDR). Methods In this prospective comparative interventional study, eyes with severe diabetic tractional macular detachment or combined tractional/rhegmatogenous retinal detachment were included. Standard 20 gauge pars plana vitrectomy, and retinal reattachment was performed. In the case group, 250 μg MTX was injected into the silicone oil at the end of surgery. The rate of retinal re-detachment associated with fibrovascular proliferation or proliferative vitreoretinopathy (PVR) was assessed. Results Overall, 38 eyes of 35 patients (19 cases and 19 controls) were studied. The two groups were matched for age, sex, preoperative visual acuity, and the type of surgery (vitrectomy alone vs combined phacoemulsification/vitrectomy). Retinal re-detachment with fibrovascular proliferation or PVR occurred in seven eyes (36.8%) in the MTX group and eight eyes (42.1%) in the control group (P = 0.74). Mean change in visual acuity was 0.04 ± 0.71 and 0.39 ± 0.70 logMAR in the MTX and the control group, respectively (P = 0.14). The rate of improvement or worsening of visual acuity was similar between the two groups (P = 0.51 and P = 0.12). Conclusion Intra-silicone injection of MTX at the end of vitrectomy for retinal detachment associated with severe PDR did not reduce the risk of postoperative retinal detachment due to the fibrous or fibrovascular proliferations.

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Section: Discussionmentioning

confidence: 99%

Intra-silicone oil injection of methotrexate at the end of vitrectomy for advanced proliferative diabetic retinopathy

Falavarjani

Modarres

Hadavandkhani

et al. 2015

Eye

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“…4,5 The first report of the use of intravitreal methotrexate in uveitis was in 2006, 6 and we reported a prospective case series of 15 patients with uveitis and uveitic CME in 2009, in which intravitreal MTX was found to be effective in controlling intraocular inflammation and improving visual acuity. 7 Usefully, the onset of action was much more rapid than that seen with systemic MTX, which takes up to 6 months to develop its full effect. 8 The duration of effect of intravitreal MTX was particularly interesting.…”

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confidence: 97%

Intraocular Methotrexate Can Induce Extended Remission in Some Patients in Noninfectious Uveitis

Taylor

Banker²,

Schlaen

et al. 2013

Retina

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In patients with uveitis and uveitic cystoid macular edema, intravitreal MTX can effectively improve visual acuity and reduce cystoid macular edema and, in some patients, allows the reduction of immunosuppressive therapy. Some patients relapse at 3 to 4 months, but a large proportion (73%) enter an extended period of remission of up to 18 months. This larger study extends the results obtained from previous smaller studies suggesting the viability of intravitreal methotrexate as a treatment option in uveitis.

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“…However, oral sirolimus was reported to have limited efficacy in treating uveitis due to its undesirable side effects (9), and there was no intravitreal formulation available at the time of the study (10). In seeking alternative drug repositioning options, we noted that methotrexate could target T cells in both healthy and rheumatoid arthritis patients, could effectively suppress ocular inflammation, and was safe for intravitreal injection (11)(12)(13)(14)(15)(16)(17)(18). Although our previous use of oral methotrexate was ineffective, the proteomic data and ability to dramatically increase local drug concentration by injection influenced us to reconsider methotrexate.…”

Section: L I N I C a L M E D I C I N Ementioning

confidence: 99%

Therapeutic drug repositioning using personalized proteomics of liquid biopsies

Vélez¹,

Bassuk²,

Colgan³

et al. 2017

JCI Insight

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IntroductionAfter spending several billion dollars and a decade or more in development and clinical trial, only approximately 10% of new drugs show efficacy and reach the market for patient use. This apparent inefficiency, however, masks enormous opportunities to repurpose existing drugs to treat diseases for which they were not originally intended, especially diseases with limited therapeutic options (1, 2). Therapies for inflammatory diseases are an attractive choice for drug repositioning because of the complexity of the immune response, the hit-or-miss nature of treatment (which is often by trial and error), and the number of traditional drugs and new biologics for inflammatory diseases.Determining which drugs to reposition, however, is not trivial. Among a heterogeneous patient population that seems affected by the same autoimmune condition, one cannot be sure if the disease is in fact the same, or at what progressive stage a patient is presenting. Currently, most predictions of patients that would benefit from drug repositioning are drawn from retrospective computational methods, genomic analyses, BACKGROUND. In patients with limited response to conventional therapeutics, repositioning of already approved drugs can bring new, more effective options. Current drug repositioning methods, however, frequently rely on retrospective computational analyses and genetic testing -time consuming methods that delay application of repositioned drugs. Here, we show how proteomic analysis of liquid biopsies successfully guided treatment of neovascular inflammatory vitreoretinopathy (NIV), an inherited autoinflammatory disease with otherwise poor clinical outcomes.

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Intraocular Methotrexate in the Treatment of Uveitis and Uveitic Cystoid Macular Edema

Cited by 111 publications

References 23 publications

Intra-silicone oil injection of methotrexate at the end of vitrectomy for advanced proliferative diabetic retinopathy

Intra-silicone oil injection of methotrexate at the end of vitrectomy for advanced proliferative diabetic retinopathy

Intraocular Methotrexate Can Induce Extended Remission in Some Patients in Noninfectious Uveitis

Therapeutic drug repositioning using personalized proteomics of liquid biopsies

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