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V. M. Fiorelli, P. Bhat, C. S. Foster; Non-Steroidal Anti-Inflammatory Therapy and Recurrent Anterior Uveitis. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2686.
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Recurrent acute anterior uveitis (AAU) is challenging and chronic corticosteroid therapy is commonly used for its treatment. We present a study of the use of prophylactic oral non steroidal anti inflammatory drugs (NSAIDs), in the prevention of recurrences of uveitis in patients with AAU.
Clinical records of 59 patients with a diagnosis of recurrent AAU between May 2005 and April 2008 who were treated with NSAIDs (celecoxib or diflunisal) and with a follow-up of one year were evaluated. Multiple variables were assessed including the time and duration of systemic NSAID use, and the recurrences of inflammation prior to and after administration of NSAID therapy. Statistical analysis was performed using the Wilcoxon test to compare the differences in relapses prior to and during NSAID treatment. The Mann-Whitney test was used to compare the differences in follow up and remission between- celecoxib and diflunisal; HLA-B27 positive and negative, and male and female groups.
The average age at presentation was 43 ± 11.7 years. The average duration of NSAID therapy was 21.2 ± 5.7 months. The average number of relapses for all patients prior to systemic NSAID therapy was 2.84 per person- year follow-up. These relapses declined to 0.53 per person- year follow-up while on NSAID therapy which was statistically significant at p < 0.001. The average follow-up for the celecoxib group was 21.9 months and the average follow-up in the diflunisal group was 18.56 months. Patients on celecoxib therapy remained in remission longer (21 ± 5.50 months) than patients on diflunisal therapy (15.34 ± 5.78 months) with p < 0.001. The relapse rate prior to treatment with NSAID in the HLA-B27 positive group (n=21) was 2.24 which dropped to 0.24 while on NSAIDs. The relapse rate prior to treatment in the HLA-B27 negative group (n=38) was 2.97 which decreased to 0.66 with treatment. The difference in the relapse rate prior to and during NSAID therapy in both groups was statistically significant at p < 0.001.
The relapse rate of uveitis is significantly reduced in patients with recurrent AAU who are treated with oral NSAIDS with systemic NSAID therapy providing respite from more frequent morbid attacks.
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