| Abstract | AbstractImmune-mediated uveitis is a collective term referring to a group of potentiallyblinding intraocular inflammations which may coexist with systemic inflammatorydiseases. T lymphocytes appear to play an important pathogenic role in uveitis, andthese cells are therefore the logical target of drug therapy. Corticosteroids actnonspecifically, but are highly effective in controlling the inflammation rapidly. Theyare administered locally when disease is confined to the anterior portion of the eye.However, posterior eye involvement often requires systemic corticosteroid therapy,carrying a high risk of serious adverse effects when used for extended periods. Inthis situation, steroid-sparing agents are used. Few relevant randomised, controlled clinical trials have been performed, and thechoice of systemic immunosuppressive regimen is usually guided by individualpatient characteristics, cost, drug availability and physician preference. Patientsshould actively participate in therapeutic decision-making. Our first choice for steroid-sparing medication is often methotrexate, anantimetabolite which carries a low risk of adverse reactions when appropriatelyprescribed and monitored, is relatively inexpensive, and has once-weekly ease ofuse. For more severe uveitis, we may combine the immunomodulating agentcyclosporin with methotrexate and a corticosteroid. Azathioprine andcyclophosphamide are other treatment options. Steroid-sparing drugs also havesignificant potential for causing adverse effects, albeit less frequently thancorticosteroids. Future therapies aim to reduce this problem by increasing thespecificity of the therapeutic action. |
| Authors | J R Smith, J T Rosenbaum
(Affiliation: Casey Eye Institute, Oregon Health Sciences University, Portland,Oregon, USA.)
|
| Journal | BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy
(BioDrugs)
Vol. 13
Issue 1
Pg. 9-20
(Jan 2000)
ISSN: 1173-8804 New Zealand |
| PMID | 18034509
(Publication Type: Journal Article)
|
