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C. Tappeiner, C. Heinz, H. Michels, G. Ganser, A. Heiligenhaus; Efficacy and Adverse Effects of Ciclosporine A in the Treatment of Chronic Anterior Uveitis in Patients With Juvenile Idiopathic Arthritis. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3913.
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Juvenile idiopathic arthritis (JIA) is often associated with chronic anterior uveitis (CAU). Severe inflammation or the development of vision-threatening complications may indicate immunosuppressive therapy. In this study, the experience with ciclosporine A (CsA) as mono- or combination-therapy and its efficacy in methotrexate-nonresponders was analyzed.
Multicenter, retrospective analysis of the clinical observations with CsA in JIA children with CAU.
Eighty-two JIA children (girls n=60, oligoarthritis n=65, RF-negative polyarthritis n=13, psoriatic arthritis n=1, other arthritis n=3) suffering from unilateral (n=55) or bilateral CAU were treated with systemic CsA (mean dosage 2.9 mg/kg, mean follow up 3.9 years). CsA was indicated by persistently active CAU despite of topical or systemic corticosteroids, etanercept, azathioprine or methotrexate. Uveitis quiescence was achieved with CsA as monotherapy in 8 out of 20 patients (40%), and in 33 out of 70 patients (47.1%) with CsA in combination with MTX (n=16), azathioprine (n=11) or others (n=6). With CsA, a reduction ≥50% of topical steroids (n=38), systemic immunosuppressives or steroids (n=21) was possible. Preexisting CME did not resolve on CsA in any of the patients. In 9 patients (11%), CsA was discontinued because of systemic hypertension (n=1), creatinine elevation (n=3), or other adverse effects (n=5).
The observations suggest that CsA as monotherapy, and in MTX nonresponders as combination therapy has limited efficacy for the treatment of JIA-associated CAU.
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