Systemic Immunomodulatory Therapy in Idiopathic Anterior Uveitis: 10-Year Profile

Authors

  • Ana Margarida Ferreira Department of Ophthalmology, Centro Hospitalar Universitário São João, Portugal https://orcid.org/0009-0000-3592-2820
  • Rodrigo Vilares-Morgado Department of Ophthalmology, Centro Hospitalar Universitário São João, Portugal; Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
  • Marta Inês Silva Department of Ophthalmology, Centro Hospitalar Universitário São João, Portugal
  • Catarina Pedrosa Department of Ophthalmology, Centro Hospitalar Universitário São João, Portugal; Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
  • Cláudia Oliveira Ferreira Department of Ophthalmology, Centro Hospitalar Universitário São João, Portugal; Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
  • Sónia Torres-Costa Department of Ophthalmology, Centro Hospitalar Universitário São João, Portugal; Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
  • Luís Torrão Department of Ophthalmology, Centro Hospitalar Universitário São João, Portugal; Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
  • Luís Figueira Department of Ophthalmology, Centro Hospitalar Universitário São João, Portugal; Center for Drug Discovery and Innovative Medicines (MedInUP) of the University of Porto, Porto, Portugal
  • Joana Rodrigues Araújo Department of Ophthalmology, Centro Hospitalar Universitário São João, Portugal; Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal

DOI:

https://doi.org/10.48560/rspo.33257

Keywords:

Immunomodulating Agents, Uveitis, Anterior/drug therapy

Abstract

INTRODUCTION: Anterior uveitis (AU) without underlying systemic disease sometimes requires immunomodulatory therapy (IMT) to control inflammation. Our primary purpose was to characterize the immunomodulatory therapy profile in patients with idiopathic AU (IAU) at our ophthalmology department.
METHODS: Data from all patients with AU under IMT evaluated in the past 10 years at the uveitis department of Hospital de S. João were reviewed. Data regarding demographics, type and duration of IMT, the pattern of disease remission and relapses were noted.
RESULTS: A total of 158 patients with AU under IMT were reviewed, from whom 30 patients with IAU were included and 128 patients with underlying systemic disease were excluded. The mean total follow-up time was 73.87±44.73 months [range 12-168]. Twenty-one patients (70%) presented bilateral involvement. The mean duration of treatment was 46.50±34.40 months and 21 patients (70%) were under IMT for at least 2 years. Methotrexate was the most widely used immunomodulator agent able to maintain disease remission (n=26, 86.7%) and the first attempt in IMT in 96.2% of the patients. Two patients (6.7%) needed the association of methotrexate and adalimumab to control the disease. Before treatment, patients presented a mean of 2.07±1.31 flare-ups per year, significantly decreasing to a mean of 0.60±0.67 relapses per year with the implementation of IMT (p<0.001). Twelve patients (40%) stopped treatment, in 5 cases (41.7%) a medical-based decision because of long-term remission of the disease, in 5 cases (41.7%) by patient initiative and in 2 cases (16.7%) because of medication side effects. Three (25%) of these 12 patients developed recurrence after a mean period of 10.67±6.43 months without IMT [range 6-18]. All patients who stopped IMT based on medical decision had been treated for a minimum of two years [range 2-5.8] without relapse of ocular inflammation.
CONCLUSION: Some patients with IAU need IMT to achieve the ultimate goal of durable remission. Methotrexate was the most widely used immunomodulatory drug for the treatment of IAU in our department. The medical decision to stop IMT based on a 2-year remission period appears to be a safe approach.

Downloads

Download data is not yet available.

References

Baarsma GS. The epidemiology and genetics of endogenous uveitis: a review. Curr Eye Res. 1992;11 Suppl:1-9. doi: 10.3109/02713689208999505.

Gritz DC, Wong IG. Incidence and prevalence of uveitis in Northern California: the Northern California epidemiology of uveitis study. Ophthalmology. 2004;111:491-500.

Bajwa A, Osmanzada D, Osmanzada S, Khan I, Patrie J, Xin W, et al. Epidemiology of uveitis in the mid-Atlantic United States. Clin Ophthalmol. 2015:889-901. doi: 10.2147/OPTH.S80972.

Birnbaum AD, Little DM, Tessler HH, Goldstein DA. Etiologies of chronic anterior uveitis at a tertiary referral center over 35 years. Ocul Immunol Inflamm. 2011;19:19-25. doi: 10.3109/09273948.2010.519852.

Kouwenberg CV, Wennink RA, Shahabi M, Bozkir I, Ayuso VK, De Boer JH. Clinical course and outcome in pediatric idiopathic chronic anterior uveitis. Am J Ophthalmol. 2022;241:198-205. doi: 10.1016/j.ajo.2022.04.015

Sen HN, Vitale S, Gangaputra SS, Nussenblatt RB, Liesegang TL, Levy-Clarke GA, et al. Periocular corticosteroid injections in uveitis: effects and complications. Ophthalmology. 2014;121:2275-86. doi: 10.1016/j.ophtha.2014.05.021.

Jabs DA, Rosenbaum JT, Foster CS, Holland GN, Jaffe GJ, Louie JS, et al. Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel. Am J Ophthalmol. 2000;130:492-513. doi: 10.1016/s0002-9394(00)00659-0.

Foster CS, Kothari S, Anesi SD, Vitale AT, Chu D, Metzinger JL, et al. The Ocular Immunology and Uveitis Foundation preferred practice patterns of uveitis management. Surv Ophthalmol. 2016;61:1-17. doi: 10.1016/j.survophthal.2015.07.001.

Rothova A, Suttorp-van Schulten M, Treffers WF, Kijlstra A. Causes and frequency of blindness in patients with intraocular inflammatory disease. Br J Ophthalmol. 1996;80:332-6. doi: 10.1136/bjo.80.4.332.

Millán-Longo C, Peiteado D, Schlincker A, Hidalgo V, Pieren A, Balsa A, et al. Use of Immunomodulatory Drugs at a Uveitis Clinic. Reumatol Clín. 2019;15:271-6. doi: 10.1016/j.reuma.2017.09.008.

Balasubramaniam B, Chong YJ, Azzopardi M, Logeswaran A, Denniston AK. Topical anti-inflammatory agents for non-infectious uveitis: current treatment and perspectives. J Inflamm Res. 2022;15:6439-51. doi: 10.2147/JIR.S288294.

Jakob E, Reuland MS, Mackensen F, Harsch N, Fleckenstein M, Lorenz HM, et al. Uveitis subtypes in a German interdisciplinary uveitis center—analysis of 1916 patients. J Rheumatol. 2009;36:127-36. doi: 10.3899/jrheum.080102.

Neti N, Pimsri A, Boonsopon S, Tesavibul N, Choopong P. Triggering factors associated with a new episode of recurrent acute anterior uveitis. Sci Rep. 2021;11:12156. doi: 10.1038/s41598-021-91701-6.

Saari K, Päivönsalo‐Hietanen T, Vaahtoranta‐Lehtonen H, Tuominen J, Sillanpää M. Epidemiology of endogenous uveitis in south‐western Finland. Acta Ophthalmol Scand. 1995;73:345-9. doi: 10.1111/j.1600-0420.1995.tb00040.x.

Agrawal RV, Murthy S, Sangwan V, Biswas J. Current approach in diagnosis and management of anterior uveitis. Indian J Ophthalmol. 2010;58:11-9. doi: 10.4103/0301-4738.58468. P 16. Bora NS, Matta B, Bora PS. Immune mechanisms in the pathogenesis of idiopathic anterior uveitis. J Immunol. 2018;200:45.29-45.29.

Harada Y, Hiyama T, Kiuchi Y. Methotrexate effectively controls ocular inflammation in japanese patients with non-infectious uveitis. Front Med. 2021;8:732427. doi: 10.3389/fmed.2021.732427.

Gangaputra S, Newcomb CW, Liesegang TL, Kaçmaz RO, Jabs DA, Levy-Clarke GA, et al. Methotrexate for ocular inflammatory diseases. Ophthalmology. 2009;116:2188-98. e1. doi: 10.1016/j.ophtha.2009.04.020.

Martin C, Muls V, Brasseur C, Meric de Bellefon L, Lam Hoai XL, Vanderhilst J, et al. ImmunoStart: preparing patients for immunosuppression. Rheumatol Adv Pract. 2021;5:rkab092. doi: 10.1093/rap/rkab092.

Sobrin L, Pistilli M, Dreger K, Kothari S, Khachatryan N, Artornsombudh P, et al. Factors predictive of remission of chronic anterior uveitis. Ophthalmology. 2020;127:826-34. doi: 10.1016/j.ophtha.2019.11.020.

Downloads

Published

2024-12-12

How to Cite

Ferreira, A. M., Vilares-Morgado, R., Silva, M. I., Pedrosa, C., Oliveira Ferreira, C., Torres-Costa, S., Torrão, L., Figueira, L., & Rodrigues Araújo, J. (2024). Systemic Immunomodulatory Therapy in Idiopathic Anterior Uveitis: 10-Year Profile. Revista Sociedade Portuguesa De Oftalmologia. https://doi.org/10.48560/rspo.33257

Issue

Pré-Publicação

Section

Original Article

License

Copyright (c) 2024 Revista Sociedade Portuguesa de Oftalmologia

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Do not forget to download the Authorship responsibility statement/Authorization for Publication and Conflict of Interest.
The article can only be submitted with these two documents.
To obtain the Authorship responsibility statement/Authorization for Publication file, click here.

To obtain the Conflict of Interest file (ICMJE template), click here