Limited value of cyclosporine A for the treatment of patients with uveitis associated with juvenile idiopathic arthritis

Tappeiner, Christoph; Roesel, Martin; Heinz, Carsten; Michels, H.; Ganser, Gerd; Heiligenhaus, Arnd

doi:10.1038/eye.2008.174

Cited by 76 publications

(35 citation statements)

References 17 publications

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“…However, only a few publications exist on its efficacy in treating JIA-associated uveitis [65][66][67][68][69][70][71]. Consensus was reached that cyclosporine A alone was only mildly effective and thus should not be employed as the primary immunosuppressive to treat JIA-associated uveitis (IIIA).…”

Section: Treatment With Immunosuppressives and Biologicalsmentioning

confidence: 99%

Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis

et al. 2011

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Uveitis in juvenile idiopathic arthritis (JIA) is frequently associated with the development of complications and visual loss. Topical corticosteroids are the first-choice therapy, and immunosuppression is commonly used. However, treatment has not been standardized. Representatives from the German Ophthalmological Society, Society for Childhood and Adolescent Rheumatology, and the German Society for Rheumatology reached consensus on a standardized treatment strategy according to disease severity in the individual patient. The recommendations were based on a systematic literature analysis in MEDLINE and consensus expert meetings. Evidence and recommendations were graded, and an algorithm for anti-inflammatory treatment and final statements confirmed in a Delphi method. An interdisciplinary, evidence-based treatment guideline for JIA uveitis is presented.

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Section: Treatment With Immunosuppressives and Biologicalsmentioning

confidence: 99%

Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis

et al. 2011

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“…Current guidelines for the use of immunosuppressive drugs [87] recommend corticosteroids as the first-line therapy for patients who present with active uveitis and the subsequent addition of immunosuppressive agents in the management of resistant AU, also with steroid-sparing purpose. Table 1 summarizes the largest clinical trials published in the last 10 years [88][89][90][91][92][93][94][95][96][97][98][99][100][101][102] on systemic immunosuppressive treatment of AU, excluding those with \20 patients. The selected trials include I-AU and SDA-AU, in adults and children.…”

Section: Treatment Of Autoimmune Uveitismentioning

confidence: 99%

Autoimmune uveitis: clinical, pathogenetic, and therapeutic features

et al. 2015

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Autoimmune uveitis (AU), an inflammatory non-infectious process of the vascular layer of the eye, can lead to visual impairment and, in the absence of a timely diagnosis and suitable therapy, can even result in total blindness. The majority of AU cases are idiopathic, whereas fewer than 20 % are associated with systemic diseases. The clinical severity of AU depends on whether the anterior, intermediate, or posterior part of the uvea is involved and may range from almost asymptomatic to rapidly sight-threatening forms. Race, genetic background, and environmental factors can also influence the clinical picture. The pathogenetic mechanism of AU is still poorly defined, given its remarkable heterogeneity and the many discrepancies between experimental and human uveitis. Even so, the onset of AU is thought to be related to an aberrant T cell-mediated immune response, triggered by inflammation and directed against retinal or cross-reactive antigens. B cells may also play a role in uveal antigen presentation and in the subsequent activation of T cells. The management of AU remains a challenge for clinicians, especially because of the paucity of randomized clinical trials that have systematically evaluated the effectiveness of different drugs. In addition to topical treatment, several different therapeutic options are available, although a standardized regimen is thus far lacking. Current guidelines recommend corticosteroids as the first-line therapy for patients with active AU. Immunosuppressive drugs may be subsequently required to treat steroid-resistant AU and for steroid-sparing purposes. The recent introduction of biological agents, such as those targeting tumor necrosis factor-α, is expected to remarkably increase the percentages of responders and to prevent irreversible sight impairment. This paper reviews the clinical features of AU and its crucial pathogenetic targets in relation to the current therapeutic perspectives. Also, the largest clinical trials conducted in the last 12 years for the treatment of AU are summarized and critically discussed.

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“…ESR and CRP level were considered abnormal if they were Ͼ35 mm and Ͼ0.5 mg/dl, respectively; the white blood cell count and hemoglobin level were considered to be abnormal if they were greater or lower than 2 SD values for age. The platelet count was considered abnormal if it was Ͼ400 ϫ 10 3 /mm 3 . ALT and AST were considered abnormal if they were Ͼ40 units/liter, creatinine if it was Ͼ62moles/liter or Ͼ0.47 mg/dl, and BUN if it was Ͼ6.40 mmoles/liter.…”

Section: Methodsmentioning

confidence: 99%

Abatacept for severe anti–tumor necrosis factor α refractory juvenile idiopathic arthritis–related uveitis

Zulian¹,

Balzarin²,

Falcini³

et al. 2010

Arthritis Care & Research

172

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Objective. To evaluate the safety and efficacy of abatacept in patients with severe juvenile idiopathic arthritis (JIA)-related uveitis refractory or intolerant to immunosuppressive and anti-tumor necrosis factor ␣ (anti-TNF␣) agents. Methods. Patients with JIA-related uveitis refractory to immunosuppressive and anti-TNF␣ agents were treated with intravenous abatacept (10 mg/kg monthly). Side effects, frequency of uveitis flares, and ocular complications before and after treatment were reported. Results. Seven patients (6 females and 1 male) with a mean uveitis duration of 11.6 years entered the study. All patients had failed previous immunosuppressive therapy and >2 anti-TNF␣ treatments. All patients responded to abatacept and 6 maintained a clinical remission after a mean of 9.2 months of treatment. One patient withdrew from the study with oral mycosis and arthritis flare; no other patients had side effects. The mean frequency of uveitis flares during the 6 months before and after treatment decreased from 3.7 to 0.7 episodes. No new ocular complications or worsening of preexisting ones were reported. Conclusion. Abatacept treatment led to sustained improvement in severe anti-TNF␣-resistant JIA-related uveitis and was well tolerated in all but 1 patient. These results provide new insights into a possible indication of abatacept for the treatment of uveitis.

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Limited value of cyclosporine A for the treatment of patients with uveitis associated with juvenile idiopathic arthritis

Cited by 76 publications

References 17 publications

Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis

Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis

Autoimmune uveitis: clinical, pathogenetic, and therapeutic features

Abatacept for severe anti–tumor necrosis factor α refractory juvenile idiopathic arthritis–related uveitis

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