Multicenter Study of Intravitreal Dexamethasone Implant in Noninfectious Uveitis: Indications, Outcomes, and Reinjection Frequency

Zarranz‐Ventura, Javier; Carreño, Ester; Johnston, Robert L.; Mohammed, Quresh; Ross, Adam H; Barker, Carl; Fonollosa, Alex; Artaraz, Joseba; Pelegrín, Laura; Adán, Alfredo; Lee, Richard W.; Dick, Andrew D.; Sallam, Ahmed

doi:10.1016/j.ajo.2014.09.003

Cited by 110 publications

(84 citation statements)

References 21 publications

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“…18 Significant improvements in central retinal thickness were reported in one study up to 6 months after a single implant 82 and in another study up to 3 months, with a return to baseline by 6 months. 83 Studies in which patients received between one and four implants reported improvements in BCVA at 12 months, 50,83,86 with the improvements reported to be significant in one study. 50 Among studies with patients having a mix of single or multiple implants and macular oedema, significant improvements in central retinal thickness were reported up to 12 months in one study, 50 with another study reporting significant improvements at 3 months but not at 6 months.…”

Section: Dexamethasone Studiesmentioning

confidence: 97%

“…83 Studies in which patients received between one and four implants reported improvements in BCVA at 12 months, 50,83,86 with the improvements reported to be significant in one study. 50 Among studies with patients having a mix of single or multiple implants and macular oedema, significant improvements in central retinal thickness were reported up to 12 months in one study, 50 with another study reporting significant improvements at 3 months but not at 6 months. 85 In terms of repeat implants, one study reported that after the second implant BCVA improved significantly by 1 month but then decreased, with a similar trend following up to six implants (not significant but small patient numbers).…”

Section: Dexamethasone Studiesmentioning

confidence: 97%

“…18 Another study reported that the improvements in BCVA and central retinal thickness at 1 month were similar (not significantly different) following the first and second implants. 84 In a study of uveitis patients the median time from first to second implant was 10 months 50 whereas in four studies of uveitic macular oedema the mean/median time from first to second implant was 4.7, 81 5.0, 51 7.1 83 and 10 86 months. The mean time from second to third implant was 3.4 months in one study of uveitic macular oedema.…”

Section: Dexamethasone Studiesmentioning

confidence: 99%

“…Table 3 shows the 6-monthly costs of DEX and ADA. One DEX implant is expected to last around 6 months, based on observational trial data 18,50,51 and clinical advice. It should be noted that patients could receive Chapter 2 Definition of the decision problem T his study assessed the clinical effectiveness and cost-effectiveness of ADA (via subcutaneous injections) and a DEX intravitreal implant for treating inflammation of the posterior segment of the eye presenting as non-infectious uveitis.…”

Section: Current Usage In the Nhsmentioning

confidence: 99%

“…18,50,51,[79][80][81][82][83][84][85][86] This is based on data from the company submission for DEX; 43 the original study publications have not been examined because of time constraints. These data are included here as they provide some data on repeat implants, implants in both eyes and corticosteroid reduction, which were not assessed in the HURON trial.…”

Section: Dexamethasone Studiesmentioning

confidence: 99%

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A systematic review and economic evaluation of adalimumab and dexamethasone for treating non-infectious intermediate uveitis, posterior uveitis or panuveitis in adults

Squires

Poku

Bermejo

et al. 2017

Health Technol Assess

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Declared competing interests of authors: Fahd Quhill has received personal fees from Allergan for participation in medical education and training, and has participated in advisory boards given his clinical expertise in the role of steroids in diabetic macular oedema. He has also received support from Allergan to attend international conferences.Published November 2017 DOI: 10.3310/hta21680 This report should be referenced as follows: This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: journals.library@nihr.ac.ukThe full HTA archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hta. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Technology Assessment journalReports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hta This reportThe research reported in this issue of the journal was commissioned and funded by the HTA programme on behalf of NICE as project number 15/64/07. The protocol was agreed in June 2016. The assessment report began editorial review in December 2016 and was accepted for publication in May 2017. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expre...

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Section: Dexamethasone Studiesmentioning

confidence: 97%

Section: Dexamethasone Studiesmentioning

confidence: 97%

Section: Dexamethasone Studiesmentioning

confidence: 99%

Section: Current Usage In the Nhsmentioning

confidence: 99%

Section: Dexamethasone Studiesmentioning

confidence: 99%

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A systematic review and economic evaluation of adalimumab and dexamethasone for treating non-infectious intermediate uveitis, posterior uveitis or panuveitis in adults

Squires

Poku

Bermejo

et al. 2017

Health Technol Assess

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Clinical Presentation, Management, and Long‐Term Outcome of Pars Planitis, Panuveitis, and Vogt‐Koyanagi‐Harada Disease in Children and Adolescents

Reiff

2020

Arthritis Care & Research

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Objective. Chronic uveitis is a common manifestation of pediatric rheumatologic conditions and may result in irreversible blindness and long-term disability. While chronic anterior uveitis is the most commonly encountered ocular manifestation of rheumatic disease, little is known about the clinical presentation, management, and long-term outcome of more complex eye conditions such as pars planitis (PP), panuveitis (PU), and Vogt-Koyanagi-Harada disease (VKH). The present study was undertaken to comprehensively assess the long-term safety and efficacy of disease-modifying antirheumatic drugs (DMARDs) and biologics for the treatment of pediatric and adolescent patients with PP, PU, and VKH. Methods. We retrospectively reviewed a cohort of 75 children and adolescents with idiopathic PP (n = 50), PU (n = 11), and VKH (n = 14) followed by the Pediatric Rheumatology Core at Children's Hospital Los Angeles and evaluated referral patterns, clinical presentation, treatment response, and long-term clinical outcome. Results. Patients were followed for an average of 52 months. The mean age at disease onset was 10 years. Bilateral eye involvement was seen in 87% of the patients. At first presentation to an ophthalmologist, glaucoma was noted in 21%, and vision loss (<20/40) in 87% of patients, while legal blindness (≤20/200 in the better-seeing eye) was diagnosed in 18 of 75 (24%) patients (PP 22%, PU 36%, and VKH 21%). The average referral time to a pediatric rheumatologist was 13 months (range 1-96 months). Topical steroids were used in all patients, but 98% of patients required additional DMARDs, and 73% required therapy with biologics. After a mean of 52 months, 35% of patients across all disease groups had significant vision loss or were blind, and only 28% were in clinical remission without medications. The worst outcome was observed in children with PU. Application of regression analysis demonstrated that young age at onset, delayed referral to a pediatric rheumatologist, and chronic disease were strong predictors for the risk of long-term blindness. Conclusion. PP, PU, and VKH involve a high risk of permanent vision loss and should be managed by a skilled rheumatologist as early and as aggressively as possible.

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Pharmacologic Treatment of Noninfectious Uveitis

Knickelbein

Armbrust

Kim

et al. 2016

Handbook of Experimental Pharmacology

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Uveitis encompasses a spectrum of diseases whose common feature is intraocular inflammation, which may be infectious or noninfectious in etiology (Nussenblatt and Whitcup 2010). Infectious causes of uveitis are typically treated with appropriate antimicrobial therapy and will not be discussed in this chapter. Noninfectious uveitides are thought have an autoimmune component to their etiology and are thus treated with anti-inflammatory agents.

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Multicenter Study of Intravitreal Dexamethasone Implant in Noninfectious Uveitis: Indications, Outcomes, and Reinjection Frequency

Cited by 110 publications

References 21 publications

A systematic review and economic evaluation of adalimumab and dexamethasone for treating non-infectious intermediate uveitis, posterior uveitis or panuveitis in adults

A systematic review and economic evaluation of adalimumab and dexamethasone for treating non-infectious intermediate uveitis, posterior uveitis or panuveitis in adults

Clinical Presentation, Management, and Long‐Term Outcome of Pars Planitis, Panuveitis, and Vogt‐Koyanagi‐Harada Disease in Children and Adolescents

Pharmacologic Treatment of Noninfectious Uveitis

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