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B. N. Phillips, K. J. Wroblewski; Retrospective Analysis of Oral Sirolimus in Active, Non-Infectious Uveitis. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5264.
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To determine the efficacy and safety of oral low dose sirolimus in the treatment of patients with active, non-infectious anterior, intermediate and posterior uveitis.
Retrospective, non-comparative case series. Eight patients were enrolled. Age of patients ranged from 21 to 67 years with a mean of 49 years. Diagnoses included SO, sarcoidosis, idiopathic, etc. Duration of treatment ranged from 1 month to 6 months. Inclusion criteria included patients with acitve, non-infectious uveitis whose disease was not controlled with topical agents. Sirolimus was started at 1-2mg PO and increased to 3-4mg as needed to titrate blood levels to 4ng/ml-12ng/ml. Symptomatic improvement, visual acuity, intraocular inflammation (SUN criteria), OCT findings, efficacy and adverse events were measured.
Sirolimus monotherapy was ineffective in three of four patients, all of whom had worsening inflammation with reduced corticosteroid dosage. One patient stopped taking sirolimus when symptoms decreased and did not follow up. Combination therapy with sirolimus and another immunomodulatory agent was effective in four of four patients, all of whom had their dose of corticosteroid reduced or discontinued. One patient developed meningitis and sirolimus was stopped. Other side effects included hyperlipidemia and cold-like symptoms.
Low dose oral sirolimus monotherapy was ineffective in quelling active inflammation and was best used in combination with another agent to decrease corticosteroid requirement. Further studies are needed to fully determine the synergistic effects of sirolimus with other immunomodulatory drugs.
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