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Emmanuelle Champion, Bahram Bodaghi, Nathalie Cassoux, Celine Terrada, Cedric Aknin, Christine Fardeau, Phuc LeHoang; Efficacy And Safety Of Immunomodulatory Agents In Patients With Posterior And Total Non- Infectious Uveitis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2764.
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To evaluate indications, efficacy and safety of immunomodulators in severe posterior and total non-infectious uveitis.
Medical records of 308 patients referred between 2006 and 2008 to a tertiary center, specialized in the management of ocular inflammation, for an etiological work-up, initiation of intravenous corticosteroids or immunomodulators were analyzed. Patients who received an immunosuppressive treatment during this period and who were followed up at least 18 months, were included in this retrospective study. Main outcome parameters were BCVA, score of intraocular inflammation (according to the Standardization of Uveitis Nomenclature criteria) and corticosteroids dosage at the end of the follow-up.
34 patients were included in this study. The most prescribed treatments were interferon alpha (22 patients, 31%), azathioprine (19, 27%) and methotrexate (10, 14%) while mycophenolat mofetil, infliximab, cyclophosphamide and cyclosporine were the least used (respectively 6, 5, 4 and 3 patients). There were various causes of uveitis : 7 birdshot chorioretinopathy (21%), 6 sarcoidosis (17%), 3 Behçet disease (9%), 3 sympathetic ophtalmia (9%), 2 Vogt-Koyanagi-Harada disease (6%), 1 multifocal chorioretinopathy (3%) and 12 idiopathic uveitis (35%). At 18 months of follow up, BCVA remained stable in 70.5% of cases, improved (gain at least 2 lines) in 20.5% and worsened (loss at least 2 lines) in 9% of cases (p = 0.1). The most effective treatments on inflammation were MMF, interferon alpha and azathioprine, respectively 83, 71 and 68% of initial efficacy : two step decrease in level of inflammation or decrease to grade 0. Interferon treated effectively 75% of patients with macular edema. Steroid sparing was achieved in half of the cases treated with azathioprine, MMF and interferon alpha (p = 0.001) during the observation period.Interferon alpha induced the highest rate of side effects (77% of cases). Most of these side effects were moderate. The most common were depressive syndrome (32% of patients), asthenia (27%) and fever (27%). The most serious side effects were caused by cyclosporine A (severe arterial hypertension (33%) and peripheral neuropathy (33%).
All immunosuppressive treatments have a certain efficacy to treat severe non infectious uveitis. The choice of the treatment depends on patient’s medical history, etiology of uveitis, initial severity of inflammation and resistance to other molecules.
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