Long-term Follow-up of Patients with Birdshot Retinochoroidopathy Treated with Corticosteroid-Sparing Systemic Immunomodulatory Therapy

Kiss, Szilárd; Ahmed, Muna; Letko, Erik; Foster, C. Stephen

doi:10.1016/j.ophtha.2004.12.036

Cited by 111 publications

(85 citation statements)

References 17 publications

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“…Subsequent studies have replicated these findings in a variety of uveitic syndromes including birdshot retinochoroidopathy [23] childhood uveitis [24], ocular cicatricial pemphigoid, scleritis, and panuveitis [25]. In a multicenter, interventional case series of patients with uveitis treated with subcutaneous daclizumab, 10 of 15 patients (67%) were able to taper their immunosuppressive medications while on daclizumab, achieving their primary endpoint of a 50% reduction in immunosuppressive medication [26].…”

Section: Discussionmentioning

confidence: 86%

High-dose humanized anti-IL-2 receptor alpha antibody (daclizumab) for the treatment of active, non-infectious uveitis

Yeh

Wroblewski

Buggage

et al. 2008

Journal of Autoimmunity

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Purpose-This study was designed to provide preliminary data regarding the safety and efficacy of high-dose humanized anti-IL-2 receptor (daclizumab) therapy for the treatment of active intermediate, posterior or panuveitis.Methods-Five patients were recruited into this non-randomized, prospective pilot study of highdose intravenous induction daclizumab therapy given at doses of 8 mg/kg at day 0 and 4 mg/kg at day 14. Patients who did not meet a safety endpoint at the 3-week follow-up evaluation were given the option of continuing therapy with subcutaneous daclizumab at 2 mg/kg every 4 weeks for 52 weeks. The primary outcome assessed was a 2-step decrease in vitreous haze at day 21. Secondary outcomes evaluated included best-corrected visual acuity, retinal thickness as measured by optical coherence tomography, retinal vascular leakage assessed by fluorescein angiography, anterior chamber and vitreous cellular inflammation.Results-4 male patients and 1 female patient were enrolled. Diagnoses included birdshot retinochoroidopathy (2 patients), Vogt-Koyanagi-Harada's disease, bilateral idiopathic panuveitis and bilateral idiopathic intermediate uveitis. By the 4 th week, four of five patients demonstrated a 2-step decrease in vitreous haze. The other participant did not meet this criterion until week 20, but all 5 patients maintained stability in vitreous haze grade throughout their follow-up periods. At enrollment, mean visual acuity (10 eyes in five patients) was 69.2 ETDRS letters and following treatment was 78.2 letters (p < 0.12). Anterior chamber cell, vitreous cell, and vitreous haze also improved in the majority of eyes. Adverse events were generally mild except for one episode of leftlower lobe pneumonia requiring hospitalization and treatment.Conclusion-This is the first demonstration that high-dose daclizumab can reduce inflammation in active uveitis. Daclizumab was well-tolerated but there may be a potential increased risk of infection associated with immunosuppression. All five patients demonstrated a decrease in vitreous haze and measures of intraocular inflammation at final follow-up. The results of this small,

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Section: Discussionmentioning

confidence: 86%

High-dose humanized anti-IL-2 receptor alpha antibody (daclizumab) for the treatment of active, non-infectious uveitis

Yeh

Wroblewski

Buggage

et al. 2008

Journal of Autoimmunity

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“…There is increasing evidence that aggressive and sustained treatment is probably needed in the majority of patients; [41,42] not more than 10-15 % of patients present a relatively mild course [8]. Once the diagnosis is established, our criterion to treat is the occurrence of visual field defects.…”

Section: Therapy and Evolutionmentioning

confidence: 99%

New concepts in the appraisal and management of birdshot retinochoroiditis, a global perspective

Papadia¹,

Herbort

2015

Int Ophthalmol

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Birdshot retinochoroiditis (BRC) is a relatively recently described entity. BRC uveitis is predominant in the posterior segment with dual, independent retinal, and choroidal inflammation. The disease has no known extra-ocular inflammation sites and yet features the strongest known HLA association: HLA-A29 is present in close to 100 % of cases. Aim in this mini-review was to readjust the appraisal of BRC in the light of a global approach including the full array of investigational procedures. Historical background and the genesis of the disease name were searched. Global disease description including both the retina and the choroid was given. Retinal involvement was clearly characterized, pointing toward the profuse leakage of retinal vessels of all sizes in early disease and widespread atrophy in under treated patients. The importance of exploration of choroidal disease, unavailable until the early 1990s before the advent of indocyanine green angiography (ICGA) was stressed, allowing early diagnosis of disease. Despite its proven importance to explore the choroid, ICGA is still sparsely used. Existing diagnostic criteria were found to be clearly inappropriate not allowing early diagnosis and are in need to be revised, taking into account both retinal and choroidal aspects of the disease, in order to make early diagnosis possible and hence allow proper management .

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“…Despite intensive antiinflammatory therapies, patients exhibit a slow decline in visual function. 1,[5][6][7] The most frequent cause of central visual loss is cystoid macular edema (CME) and subsequent macular atrophy. As yet, no curative treatment has been identified, and there is an urgent need to determine optimal methods for treating and monitoring patients with BSCR.…”

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confidence: 99%

Efficacy of Low-Dose Methotrexate Treatment in Birdshot Chorioretinopathy

Rothová¹,

Norel²,

Los³

et al. 2011

Retina

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Long-term Follow-up of Patients with Birdshot Retinochoroidopathy Treated with Corticosteroid-Sparing Systemic Immunomodulatory Therapy

Cited by 111 publications

References 17 publications

High-dose humanized anti-IL-2 receptor alpha antibody (daclizumab) for the treatment of active, non-infectious uveitis

High-dose humanized anti-IL-2 receptor alpha antibody (daclizumab) for the treatment of active, non-infectious uveitis

New concepts in the appraisal and management of birdshot retinochoroiditis, a global perspective

Efficacy of Low-Dose Methotrexate Treatment in Birdshot Chorioretinopathy

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