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N. Bouchenaki, V. Tran, C.P. Herbort; The Role of Systemic Corticosteroids and Immunosuppressive Therapy in Childhood Uveitis . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2405.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To evaluate the indications and the contribution of systemic corticosteroids and immunosuppressive therapy in childhood uveitis in a secondary referral center. Methods: A retrospective case series of children with a chronic or recurrent uveitis who were treated systemically either with corticosteroids and/or immunosuppressive treatment. Indications, efficacy and side effects were analysed. Results: From 1995 to 2002, 742 new uveitis patients were seen in the uveitis clinic at La Source Eye Center, Lausanne, Switzerland, of whom 78 (10.5%) were aged less than 18 years when uveitis started. Thirty-three children (42%) received systemic therapy. Among them, sixteen (48.5%) (7girls, 9 boys) received systemic corticosteroid therapy alone (pars planitis (6), toxoplasmosis (2), juvenile idiopathic arthritis (JIA) (2), Behcet's disease (1), inflammatory choriocapillaropathy (1), undefined diagnosis (4). Seventeen patients (51.5%) were under systemic immunosuppressive therapy and 14 patients (7 girls, 7 boys) had enough data to be included in the analysis. The diagnosis were JIA (4 patients), pars planitis (3), Behcet's disease (2), sarcoidosis (1), undetermined (4). The indications to add an other immunosuppressant were the severity of the inflammation (11 patients) and/or the need for a steroid sparing effect (6). Azathioprine was added in 10 patients, methotrexate in 5, cyclosporine in 3, entanercept in1 and colchicine in 1. Four patients had 2 and 3 patients had 3 immunosuppressants in addition to corticosteroids. After introduction of immunosuppressive therapy disease was controlled in all patients with sufficient follow-up data (n=11) and all were able to reduce their prednisone dose, with 3 patients able to discontinue it. One patient had to discontinue azathioprine (replaced by mycophenolate mofetyl) because of liver toxicity. No other severe side-effects were reported. Conclusions: A relatively large proportion of childhood uveitis needed systemic corticosteroids and immunosuppressive therapy. Azathioprine was effective in all cases used, was well tolerated and is safe as long as blood and liver tests are performed regularly. The use of steroid sparing immunosuppressive agents in the treatment of children with uveitis contributes to control inflammation and helps to avoid the adverse effects especially on growth of systemic steroids.
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