TY - JOUR
T1 - Management of immune-mediated uveitis
AU - Smith, Justine R.
AU - Rosenbaum, James T.
N1 - Funding Information:
We wish to acknowledge support for this work by the National Institute of Health (Dr Rosenbaum, Project Grants #EYO6477 and #EYO6484), Research to Prevent Blindness (Dr Rosenbaum, Unrestricted Grant), and the National Health and Medical Research Council of Australia (Dr Smith, Fellowship #997099).
PY - 2000
Y1 - 2000
N2 - Immune-mediated uveitis is a collective term referring to a group of potentially blinding intraocular inflammations which may coexist with systemic inflammatory diseases. T lymphocytes appear to play an important pathogenic role in uveitis, and these cells are therefore the logical target of drug therapy. Corticosteroids act nonspecifically, but are highly effective in controlling the inflammation rapidly. They are administered locally when disease is confined to the anterior portion of the eye. However, posterior eye involvement often requires systemic corticosteroid therapy, carrying a high risk of serious adverse effects when used for extended periods. In this situation, steroid-sparing agents are used. Few relevant randomised, controlled clinical trials have been performed, and the choice of systemic immunosuppressive regimen is usually guided by individual patient characteristics, cost, drug availability and physician preference. Patients should actively participate in therapeutic decision-making. Our first choice for steroid-sparing medication is often methotrexate, an antimetabolite which carries a low risk of adverse reactions when appropriately prescribed and monitored, is relatively inexpensive, and has once-weekly ease of use. For more severe uveitis, we may combine the immunomodulating agent cyclosporin with methotrexate and a corticosteroidl Azathioprine and cyclophosphamide are other treatment options. Steroid-sparing drugs also have significant potential for causing adverse effects, albeit less frequently than corticosteroids. Future therapies aim to reduce this problem by increasing the specificity of the therapeutic action.
AB - Immune-mediated uveitis is a collective term referring to a group of potentially blinding intraocular inflammations which may coexist with systemic inflammatory diseases. T lymphocytes appear to play an important pathogenic role in uveitis, and these cells are therefore the logical target of drug therapy. Corticosteroids act nonspecifically, but are highly effective in controlling the inflammation rapidly. They are administered locally when disease is confined to the anterior portion of the eye. However, posterior eye involvement often requires systemic corticosteroid therapy, carrying a high risk of serious adverse effects when used for extended periods. In this situation, steroid-sparing agents are used. Few relevant randomised, controlled clinical trials have been performed, and the choice of systemic immunosuppressive regimen is usually guided by individual patient characteristics, cost, drug availability and physician preference. Patients should actively participate in therapeutic decision-making. Our first choice for steroid-sparing medication is often methotrexate, an antimetabolite which carries a low risk of adverse reactions when appropriately prescribed and monitored, is relatively inexpensive, and has once-weekly ease of use. For more severe uveitis, we may combine the immunomodulating agent cyclosporin with methotrexate and a corticosteroidl Azathioprine and cyclophosphamide are other treatment options. Steroid-sparing drugs also have significant potential for causing adverse effects, albeit less frequently than corticosteroids. Future therapies aim to reduce this problem by increasing the specificity of the therapeutic action.
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U2 - 10.2165/00063030-200013010-00002
DO - 10.2165/00063030-200013010-00002
M3 - Review article
C2 - 18034509
AN - SCOPUS:0033963391
SN - 1173-8804
VL - 13
SP - 9
EP - 20
JO - BioDrugs
JF - BioDrugs
IS - 1
ER -