Methotrexate therapy for chronic noninfectious uveitis

Samson, C. Michael; Waheed, Nadia K.; Baltatzis, Stefanos; Foster, C. Stephen

doi:10.1016/s0161-6420(01)00576-0

Cited by 237 publications

(131 citation statements)

References 23 publications

Supporting

Mentioning

117

Contrasting

Unclassified

Order By: Relevance

“…JIA-associated uveitis unresponsive to corticosteroid treatment is commonly treated with methotrexate, and Samson et al have reported a 59% success rate of methotrexate as monotherapy for JIA-associated uveitis (24). Such uveitis is also treated with azathioprine, cyclosporine, chlorambucil, and cyclophosphamide; some of these agents are associated with serious increased risk of malignancy.…”

Section: Discussionmentioning

confidence: 99%

A randomized, placebo‐controlled, double‐masked clinical trial of etanercept for the treatment of uveitis associated with juvenile idiopathic arthritis

Smith

Thompson

Whitcup

et al. 2005

Arthritis & Rheumatism

278

127

View full text Add to dashboard Cite

Objective. To investigate the safety and efficacy of etanercept in the treatment of uveitis associated with juvenile idiopathic arthritis (JIA). Methods. Children who met the American College of Rheumatology diagnostic criteria for JIA with active uveitis, who had anterior chamber cells of >1؉ or requiring topical corticosteroid >3 times daily, and who were on a stable regimen for arthritis treatment were eligible. Study participants received etanercept (0.4 mg/kg) or placebo administered subcutaneously twice weekly for 6 months. All participants received open-label etanercept for an additional 6 months. Results. Five patients received placebo and 7 received etanercept. Three of the 7 patients treated with etanercept and 2 of the 5 placebo-treated patients were considered ophthalmic successes (P ‫؍‬ 1.0). One patient in each treatment group was considered a treatment failure. Three of the 7 etanercept-treated and 2 of the 5 placebo-treated patients were neither successes nor failures by our definition. There were no serious adverse events for any patient during the entire study period. Reports of minor infections were comparable in each treatment group, 71% for etanercept and 60% for placebo (P ‫؍‬ 0.58). Conclusion. In this small pilot study there was no apparent difference in the anterior segment inflammation between patients treated with etanercept and placebo. The stringent criteria used to measure ophthalmic success of treatment and the small patient population limit the implications of our findings.

show abstract

Section: Discussionmentioning

confidence: 99%

A randomized, placebo‐controlled, double‐masked clinical trial of etanercept for the treatment of uveitis associated with juvenile idiopathic arthritis

Smith

Thompson

Whitcup

et al. 2005

Arthritis & Rheumatism

278

127

View full text Add to dashboard Cite

show abstract

“…88 In a large observational case series 89 and a multicenter retrospective cohort study, 50 MTX was found to be moderately effective, but it is likely to be well tolerated with important long-term adverse effects to be rare when closely monitored; and when side effects do occur, they are likely to be reversible. 50,89 The favorable safety profile might explain why it has been the first choice among uveitis specialists in the United States. 45 MTX, however, was the only drug in which there was a significant difference in effectiveness ratings by anatomic location of inflammation, 45 with treatment success achieved most common in patients with anterior uveitis and scleritis.…”

Section: Mtxmentioning

confidence: 99%

Immunosuppressive Treatment of Non-infectious Uveitis: History and Current Choices

Zhao¹,

Zhang²

2017

cmsj

View full text Add to dashboard Cite

Non-infectious uveitis is one of the leading causes of preventable blindness worldwide. Long-term immunosuppressive treatment is generally required to achieve durable control of inflammation in posterior and panuveitis. Although systemic corticosteroids have been the gold standard of immunosuppressive treatment for uveitis since first introduced in 1950s, its side effects of long-term use often warrant an adjuvant treatment to reduce the dosage/duration of corticosteroids needed to maintain disease control. Conventional immunosuppressive drugs, classified into alkylating agent, antimetabolites and T cell inhibitors, have been widely used as corticosteroid-sparing agents, each with characteristic safety/tolerance profiles on different uveitis entities. Recently, biologic agents, which target specific molecules in immunopathogenesis of uveitis, have gained great interest as alternative treatments for refractory uveitis based on their favorable safety and effectiveness in a variety of uveitis entities. However, lack of large randomized controlled clinical trials, concerns about efficacy and safety of long-term usage, and economic burden are limiting the use of biologics in non-infectious uveitis. Local administration of immunosuppressive drugs (from corticosteroids to biologics) through intraocular drug delivery systems represent another direction for drug development and is now under intense investigation, but more evidences are needed to support their use as regular alternative treatments for uveitis. With the numerous choices belonging to different treatment modalities (conventional immunosuppressive agents, biologics and local drug delivery systems) on hand, the practice patterns have been reported to vary greatly from center to center. Factors influence uveitis specialists' choices of immunosuppressive agents may be complex and may include personal familiarity, treatment availability, safety/tolerability, effectiveness, patient compliance, cost concerns and suggestions from related specialists such as rheumatologists and pediatricians. The focus of this review is to provide an overview of each treatment modality on safety/tolerability and effectiveness, which are believed to be the two most important factors affecting treatment decision making.

show abstract

“…Proper management includes knowledge of what therapy to use and when to use it, while moving along to something else if one therapy proves to be ineffective. When NSAIDs are ineffective in preventing relapse of uveitis after the child is completely off all corticosteroid therapy, or when inflammation is overtly severe, antimetabolites (i.e., methotrexate, azathioprine, mycophenolate mofetil), calcineurin inhibitors (modified cyclosporin) in conjunction with antimetabolites, and BRMs (i.e., infliximab, adalimumab, rituximab, abatacept) have been used off label to great effect in treating chronic inflammation from JIA-associated uveitis (33)(34)(35)(36)(37)(38)(39)(40). Over the past 2 decades, BRMs have garnered greater attention in both the rheumatologic and ophthalmologic communities, given how successful these medications have become in treating some inflammation refractive to other known therapies.…”

Section: Significance and Innovationsmentioning

confidence: 99%

Importance of recognizing and preventing blindness from juvenile idiopathic arthritis–associated uveitis

Anesi

Foster

2012

Arthritis Care & Research

View full text Add to dashboard Cite

Methotrexate therapy for chronic noninfectious uveitis

Cited by 237 publications

References 23 publications

A randomized, placebo‐controlled, double‐masked clinical trial of etanercept for the treatment of uveitis associated with juvenile idiopathic arthritis

A randomized, placebo‐controlled, double‐masked clinical trial of etanercept for the treatment of uveitis associated with juvenile idiopathic arthritis

Immunosuppressive Treatment of Non-infectious Uveitis: History and Current Choices

Importance of recognizing and preventing blindness from juvenile idiopathic arthritis–associated uveitis

Contact Info

Product

Resources

About