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Biologics uveitis

Julie Gueudry, Jennifer E Thorne, Rakesh Bansie, Juergen Braun, P Martin van Hagen, Bahram Bodaghi
The treatment of articular and extra-articular manifestations associated with HLA-B27 has undergone dramatic changes over the past two decades, mainly as a consequence of the introduction of biologic agents and in particular anti-tumor necrosis factor α (anti-TNFα) agents. Uveitis is known to be the most frequent extra-articular feature in HLA-B27-associated spondyloarthritides. Topical corticosteroids and cycloplegic agents remain the cornerstones of treatment. However, biologic therapy may be effective in the management of refractory or recurrent forms of uveitis...
October 17, 2016: Ocular Immunology and Inflammation
Cem Ozgonul, Cagri Giray Besirli
Ocular toxoplasmosis, a chorioretinal infection with Toxoplasma gondii, is the most common etiology of posterior uveitis in many countries. Accurate diagnosis depends heavily on the characteristic clinical features of this disease, but atypical presentations, especially in immunocompromised patients, may create diagnostic challenges and lead to misdiagnosis and inappropriate treatment. Molecular biology techniques to diagnose ocular toxoplasmosis have been available for many years and are now accessible as standard laboratory tests in many countries...
October 11, 2016: Ophthalmic Research
Yesim Ozguler, Gulen Hatemi, Serdal Ugurlu, Emire Seyahi, Melike Melikoglu, Sermin Borekci, Ersan Atahan, Gul Ongen, Vedat Hamuryudan
The use of anti-TNF agents is associated with an increased risk of tuberculosis (TB) and anti-TNF agents are stopped when active TB develops. However, discontinuation of treatment can result in flare of the underlying disease. The charts of 22 patients who developed active TB among a cohort of 2754 patients using anti-TNF agents between 2001 and 2013 were reviewed retrospectively. Patients restarting biologics during further follow-up were identified. One patient with miliary TB died within 1 month. A biologic agent was restarted in 16 of the remaining 21 patients (76 %)...
October 3, 2016: Rheumatology International
Stephen J Balevic, C Egla Rabinovich
Uveitis refers to the presence of intraocular inflammation, and as a strict definition compromises the iris and ciliary body anteriorly and the choroid posteriorly (the uvea). Untreated, uveitis can lead to visual loss or blindness. The etiology of uveitis can include both infectious and noninfectious (usually immune-mediated) causes, the latter of which are often mediated predominantly by Th1 CD4(+) T-cells that secrete proinflammatory cytokines. Tumor necrosis factor-alpha (TNF-α) is a proinflammatory cytokine involved in the pathogenesis of uveitis, which at high concentrations can cause excess inflammation and tissue damage...
2016: Drug Design, Development and Therapy
Vanesa Calvo-Río, Montserrat Santos-Gómez, Inmaculada Calvo, Ma Isabel González-Fernández, Berta López Montesinos, Marina Mesquida, Alfredo Adán, María Victoria Hernández, Olga Maíz, Antonio Atanes, Beatriz Bravo, Consuelo Modesto, Gisela Díaz-Cordovés, Natalia Palmou-Fontana, Javier Loricera, M C González-Vela, Rosalía Demetrio-Pablo, J L Hernández, Miguel A González-Gay, Ricardo Blanco
OBJECTIVE: To assess the efficacy of Tocilizumab (TCZ) for Juvenile Idiopathic Arthritis (JIA)-associated uveitis. METHODS: Multicenter study of patients with JIA-associated uveitis refractory to conventional immunosuppressive drugs and anti-TNFα agents. RESULTS: We assessed 25 (21 women) patients (47 affected eyes); mean age 18.5±8.3 years. Uveitis was bilateral in 22. Cystoid macular edema (CME) was present in 9 patients. Ocular sequelae found at TCZ onset included: cataracts (13), glaucoma (7), synechiae (10), band keratopathy (12), maculopathy (9), and amblyopia (5)...
October 1, 2016: Arthritis & Rheumatology
Carolina Birolo, Maria Elisabetta Zannin, Svetlana Arsenyeva, Rolando Cimaz, Elisabetta Miserocchi, Margarita Dubko, Chantal Job Deslandre, Fernanda Falcini, Maria Alessio, Francesco La Torre, Ekaterina Denisova, Giorgia Martini, Irina Nikishina, Francesco Zulian
OBJECTIVE: Abatacept (ABA) has recently been proposed as second-line treatment in patients with juvenile idiopathic arthritis (JIA)-associated uveitis refractory to anti-tumor necrosis factor-α (anti-TNF) agents, but little is known about its efficacy as a first-line approach. The aim of the present study was to compare the safety and efficacy of ABA as a first-line biological agent (ABA-1) with that of ABA as a second-line treatment after 1 or more anti-TNF agents (ABA-2), in patients with severe JIA-related uveitis...
September 15, 2016: Journal of Rheumatology
Christoph Tappeiner, Marina Mesquida, Alfredo Adán, Jordi Anton, Athimalaipet V Ramanan, Ester Carreno, Friederike Mackensen, Kaisu Kotaniemi, Joke H de Boer, Rosa Bou, Carmen García de Vicuña, Arnd Heiligenhaus
OBJECTIVE: To report on experience using the anti-interleukin 6 receptor antibody tocilizumab (TCZ) to treat severe and therapy-refractory uveitis associated with juvenile idiopathic arthritis (JIA). METHODS: Retrospective data were gathered from patients with JIA receiving TCZ treatment for uveitis. JIA and related uveitis data (disease onset, activity, structural complications, and topical and systemic antiinflammatory treatment) were evaluated at the start of TCZ (baseline) and every 3 months during TCZ therapy...
September 15, 2016: Journal of Rheumatology
Nicholas Jones
PURPOSE: To highlight the rare but life-threatening infective consequences of immunosuppression or biologic treatment for sight-threatening uveitis. PATIENTS AND METHODS: Retrospective case series of four immunosuppressed patients with uveitis complicated by sepsis. RESULTS: The affected patients were all treated using prednisolone 10 mg/day or greater, together with oral immunosuppression (2 mycophenolate mofetil, 1 azathioprine + ciclosporin, 1 methotrexate) and, in one case, infliximab...
August 19, 2016: Ocular Immunology and Inflammation
Y Z Zheng
Noninfectious uveitis is a kind of recurrent autoimmune disease and a major cause of blindness in clinical practice. Corticosteroids are the conventional medication, but have severe side effects for long-term users, and some refractory patients are treated with immunosuppressive agents. Because the pathogenesis of uveitis is related to the autoimmune imbalance mediated by CD4 + T lymphocytes. The macrophages, lymphocytes and some cytokines are involved. The immunomodulatory therapy is targeted to block the lymphocytes, cytokines or their receptors, so as to control the inflammatory damage or minimize the recurrence of the disease...
July 2016: [Zhonghua Yan Ke za Zhi] Chinese Journal of Ophthalmology
Éric Toussirot, François Aubin
Paradoxical adverse events (PAEs) have been reported during biological treatment for chronic immune-mediated diseases. PAEs are defined as the occurrence during biological agent therapy of a pathological condition that usually responds to this class of drug. A wide range of PAEs have been reported including dermatological, intestinal and ophthalmic conditions, mainly with antitumour necrosis factor α (TNF-α) agents. True PAEs include psoriasis, Crohn's disease and hidradenitis suppurativa. Other PAEs may be qualified as borderline and include uveitis, scleritis, sarcoidosis and other granulomatous diseases (granuloma annulare, interstitial granulomatous dermatitis), vasculitis, vitiligo and alopecia areata...
2016: RMD Open
Mirinae Kim, Jae-Yon Won, Seung Yong Choi, Ji Hyeon Ju, Young-Hoon Park
PURPOSE: To assess the long-term efficacy of the most widely used anti-tumor necrosis factor alpha (TNFα) agents for treatment of HLA-B27-positive ankylosing spondylitis (AS)-related uveitis. DESIGN: Retrospective cohort study. METHODS: The medical records of 143 patients with HLA-B27-positive AS who visited Seoul St. Mary's Hospital and were taking an anti-TNFα agent for at least 1 year were studied. Subjects were divided into 3 groups according to anti-TNFα treatment: Group 1 (infliximab, 66), Group 2 (adalimumab, 45), and Group 3 (etanercept, 32)...
October 2016: American Journal of Ophthalmology
Kazuaki Sato, Yuko Mihara, Kazutaka Kanai, Yohei Yamashita, Yuya Kimura, Naoyuki Itoh
Tyrosol (Tyr) is a natural phenolic antioxidant with diverse biological activities. We compared the anti-inflammatory effects of intravenously administered Tyr versus prednisolone (PSL) in an endotoxin-induced uveitis (EIU) rat model. Intravenous administration of 100 mg/kg Tyr was performed 2 hr before, simultaneously and 2 hr after lipopolysaccharide (LPS) injection. Tyr treatment was associated with decreased inflammatory cell number, protein concentration, tumor necrosis factor (TNF)-α, PGE2 and NO levels in AqH and improvements in histopathologic evidence of EIU in ocular tissue at 24 hr after LPS injection...
June 26, 2016: Journal of Veterinary Medical Science
Hiroshi Keino, Takayo Watanabe, Wakako Taki, Makiko Nakayama, Tomoko Nakamura, Kunimasa Yan, Annabelle A Okada
OBJECTIVES: To analyse clinical features, systemic associations, treatment and visual outcomes of uveitis in children and adolescents at a tertiary centre in Tokyo. METHODS: Clinical records of 64 patients under the age of 20 years who presented between 2001 and 2013 to the Ocular Inflammation Service of the Kyorin Eye Center, Tokyo were reviewed retrospectively. RESULTS: Of the 64 patients, there was a predominance of girls (70%) and bilateral disease (81%)...
June 22, 2016: British Journal of Ophthalmology
Lydia Abásolo, Zulema Rosales, David Díaz-Valle, Alejandro Gómez-Gómez, Rayma C Peña-Blanco, Ángela Prieto-García, José Manuel Benítez-Del-Castillo, Esperanza Pato, Julián García-Feijoo, Benjamín Fernández-Gutiérrez, Luis Rodriguez-Rodriguez
PURPOSE: To assess in uveitis patients the rate of immunosuppressive drug (ISD) discontinuation in real-life clinical practice, comparing this rate among ISDs. DESIGN: Longitudinal retrospective cohort study. METHODS: We included uveitis patients attending a tertiary eye referral center from Madrid (Spain) between 1989 and 2015, prescribed any ISDs (cyclosporine, methotrexate, azathioprine, anti-TNF drugs, or others). Our main outcome was discontinuation of all ISDs owing to clinical efficacy, inefficacy, adverse drug reaction (ADR), and other medical causes...
September 2016: American Journal of Ophthalmology
Liam M Ashander, Binoy Appukuttan, Yuefang Ma, Dione Gardner-Stephen, Justine R Smith
Targeting the endothelial adhesion molecules that control leukocyte trafficking into a tissue has been explored as a biological therapy for inflammatory diseases. However, these molecules also participate in leukocyte migration for immune surveillance, and inhibiting the physiological level of an adhesion molecule might promote infection or malignancy. We explored the concept of targeting endothelial adhesion molecule transcription during inflammation in a human system. Intercellular adhesion molecule 1 (ICAM-1) mediates leukocyte migration across the retinal endothelium in noninfectious posterior uveitis...
2016: Mediators of Inflammation
L Méry-Bossard, K Bagny, G Chaby, A Khemis, F Maccari, H Marotte, J L Perrot, Z Reguiai, M L Sigal, M Avenel-Audran, T Boyé, A Grasland, J Gillard, D Jullien, E Toussirot
BACKGROUND: The development of vitiligo during treatment with biological agents is an unusual event and only a few isolated cases have been reported. OBJECTIVES: To describe the clinical characteristics and evolution of patients developing new-onset vitiligo following initiation of a biological agent for chronic inflammatory disease; and also to report the clinical course of pre-existing vitiligo under biological therapy. METHODS: This nationwide multicentre, retrospective study, carried out between July 2013 and January 2015, describes the characteristics of a large series of 18 patients (psoriasis N = 8, inflammatory rheumatic diseases N = 8, ulcerative colitis N = 1, uveitis N = 1) who developed new-onset vitiligo while receiving a biological agent...
June 13, 2016: Journal of the European Academy of Dermatology and Venereology: JEADV
Raphael Leuvenink, Florence Aeschlimann, Walter Baer, Gerald Berthet, Elvira Cannizzaro, Michael Hofer, Daniela Kaiser, Silke Schroeder, Ulrich Heininger, Andreas Woerner
BACKGROUND: To analyze the clinical presentation and complications of varicella zoster virus (VZV) infection in children with rheumatic diseases treated with immunosuppressive medication such as biological disease-modifying antirheumatic drugs (bDMARDs) and/or conventional disease-modifying antirheumatic drugs (cDMARDs), and to analyze the therapeutic approach to VZV infections with respect to the concomitant immunosuppressive treatment. METHODS: Retrospective multicenter study using the Swiss Pediatric Rheumatology registry...
2016: Pediatric Rheumatology Online Journal
Austin R Fox, Lynn K Gordon, John R Heckenlively, Janet L Davis, Debra A Goldstein, Careen Y Lowder, Robert B Nussenblatt, Nicholas J Butler, Monica Dalal, Thiran Jayasundera, Wendy M Smith, Richard W Lee, Grazyna Adamus, Chi-Chao Chan, John J Hooks, Catherine W Morgans, Barbara Detrick, H Nida Sen
PURPOSE: To develop diagnostic criteria for nonparaneoplastic autoimmune retinopathy (AIR) through expert panel consensus and to examine treatment patterns among clinical experts. DESIGN: Modified Delphi process. METHODS: A survey of uveitis specialists in the American Uveitis Society, a face-to-face meeting (AIR Workshop) held at the National Eye Institute, and 2 iterations of expert panel surveys were used in a modified Delphi process. The expert panel consisted of 17 experts, including uveitis specialists and researchers with expertise in antiretinal antibody detection...
August 2016: American Journal of Ophthalmology
Alan G Palestine, Jasleen K Singh, Jason R Kolfenbach, Daniel J Ozzello
PURPOSE: To evaluate whether cost, prior insurance authorization concerns, and subspecialty practice influence therapeutic decisions in the treatment of uveitis associated with juvenile idiopathic arthritis. METHODS: A total of 2,965 pediatric ophthalmologists, uveitis specialists, retina specialists, and rheumatologists across the United States were surveyed via e-mail regarding their choice in long-term therapy for a hypothetical patient with uveitis associated with juvenile idiopathic arthritis...
July 1, 2016: Journal of Pediatric Ophthalmology and Strabismus
Thomas Lutz, Anette Lampert, Georg F Hoffmann, Markus Ries
BACKGROUND: Rare rheumatologic diseases are a heterogeneous group of conditions associated with high morbidity. As a whole group, rare rheumatologic diseases afflict millions of people demanding for effective therapies. Therefore, we analyzed the impact of the US Orphan Drug Act on the development of anti-rheumatic orphan drugs. METHODS: Analysis of the FDA database for orphan drug designations. RESULTS: In the last three decades, out of 77 orphan drug designations, 14 orphan drug approvals were granted by the FDA for the treatment of rare rheumatologic disorders, i...
2016: Orphanet Journal of Rare Diseases
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