Abstract
Purpose :
Few data are available regarding the optimal treatment of multiple sclerosis (MS)-related uveitis.The aim of this study is to evaluate the impact of multiple sclerosis (MS) treatment and conventional immunosuppressive therapies on the recurrence rate of uveitis associated with MS.
Methods :
We conducted a retrospective, bicentric observational study of all patients with MS with at least one uveitis in two centres (May 2010-May 2019). Exclusion criteria were other cause of uveitis and follow-up less than 12 months. Treatment were divided into three groups : group 1 (first-line MS treatment ): interferon β, glatiramer acetate, dimethyl-fumarate, teriflunomide; group 2 ( second-line MS treament except fingolimod because of risk of macular edema) : natalizumab, anti-CD20 ; group 3 (conventional immunosuppressive therapies) : azathioprine, mycophenolate mofetil, methotrexate, cyclophosphamide. The primary endpoint was the number of ocular attacks per year during treatment compared to the pre-treatment period for each treament group, each patient was his or her own control. Characteristics of uveitis and treatment were reviewed.
Results :
Forty-four patients were included. Patients were followed for 7,91 years (mean) before treament versus 2,92 years during treatment. Typically, uveitis was bilateral (77%), chronic (68%) and intermediate (80%). Cystoid macular edema occured in 13 patients (30%). Besides local treatment, uveitis was managed with systemic steroids (57%), intravitreal steroids (14%) and immunosuppressants (25%). Twenty-four patients received at least one treatment of group 1, 17 of group 2 and 14 of group 3. The frequency of ocular attacks per year decreased in the 3 groups during the treatment period from 0.82 ± 1.07 to 0.12 ± 0.36 in group 1; from 0.77 ± 0.52 to 0.09 ± 0.34 in group 2; from 1.58 ± 2.36 to 0.14 ± 0.27 in group 3 (all p <0.05).
Conclusions :
MS treatment, excluding fingolimod, are associated with a decrease in frequency of uveitis recurrence. These results are reassuring for their use in patients with uveitis and support a potential combined neurological and ocular effect.
This is a 2020 ARVO Annual Meeting abstract.