Abstract
Purpose :
Controversy exists regarding a 4 drug anti-tuberculosis therapy (ATT) in uveitis patients having latent tuberculosis, esp. when therapy with corticosteroids and/or other immunosuppressants is initiated. We performed a retrospective analysis of patients being treated because of latent tuberculosis-associated uveitis from 2016-18.
Methods :
16 patients (n=32 eyes) (mean age 50±16 years; ratio f:m=10:6) with chronic posterior uveitis were included. All patients had a positive QuantiFERON®-TB Gold test and were diagnosed with latent tuberculosis-associated uveitis after excluding other causes of granulomatous uveitis and normal chest imaging. Patients with an active tuberculosis (TBC) were excluded.
Ophthalmological evaluation - including BCVA, slit lamp examination, funduscopy, fluorescein angiography and OCT images-were performed before therapy, at month 3, 6, 12, and at the last follow up.
Results :
Before initiating therapy all patients had active chorioretinitis with occlusive (n=8 eyes) and non-occlusive retinal vasculitis (n=24 eyes). Mean follow up was 15±9 months. Treatment was started with systemic corticosteroids (1-2mg/kg bw prednisolone) in 15 patients. One patient had corticosteroid related side effects and received monotherapy with adalimumab instead. Corticosteroids were tapered to a maintenance dosage (<10mg/d). Additional immunosuppressive treatment with c-or b-DMARDs had to be initiated in 11 patients due to recurrences of uveitis while tapering the systemic corticosteroids: 6 patients took azathioprine(AZA) alone, 2 patients with adalimumab, 3 patients with methotrexate (MTX). One patient received a combination of adalimumab and MTX. During follow up in 2 patients of the AZA group medication was switched to adalimumab (n=1 patient) and to MTX (n=1 patient) due to elevated liver enzymes. In one patient MTX treatment had to be switched to AZA due to hair loss. As anti-TBC prophylaxis therapy we administered in 11 patients isoniazid (INH 300mg/d) additional to immunosuppression. No patient developed active TBC infection. All patients had no recurrence of uveitis during follow up.
Conclusions :
Our results demonstrate that additional 4-drug ATT is not necessary for efficient treatment of latent TBC associated-uveitis. Due to possible activation of TBC, especially in patients receiving TNF-alpha blocking agents, INH prophylaxis treatment is essential.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.