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Immunosuppressive Treatment of Non-infectious Uveitis: History and Current Choices
- Affiliations：
Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
- Author bio：
*Corresponding author Tel/Fax: 86-10-69156351, E-mail: meifen_zhang531@hotmail.com
- Funds：
DOI：
CLC：-
Published：2017-04
- Accepted：
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Zhao Chan, Zhang Meifen. Immunosuppressive Treatment of Non-infectious Uveitis: History and Current Choices[J]. Chinese medical sciences journal, 2017, 32(1): 48-61.
摘要
Abstract
Non-infectious uveitis is one of the leading causes of preventable blindness worldwide. Long-term immunosuppressive treatment is generally required to achieve durable control of inflammation in posterior and panuveitis. Although systemic corticosteroids have been the gold standard of immunosup- pressive treatment for uveitis since first introduced in 1950s
its side effects of long-term use often warrant an adjuvant treatment to reduce the dosage/duration of corticosteroids needed to maintain disease control. Conventional immunosuppressive drugs
classified into alkylating agent
antimetabolites and T cell inhibitors
have been widely used as corticosteroid-sparing agents
each with characteristic safety/tolerance profiles on different uveitis entities. Recently
biologic agents
which target specific molecules in immunopathogenesis of uveitis
have gained great interest as alternative treatments for refractory uveitis based on their favorable safety and effectiveness in a variety of uveitis entities. However
lack of large randomized controlled clinical trials
concerns about efficacy and safety of long-term usage
and economic burden are limiting the use of biologics in non-infectious uveitis. Local administration of immunosuppressive drugs (from corticosteroids to biologics) through intraocular drug delivery systems represent another direction for drug development and is now under intense investigation
but more evidences are needed to support their use as regular alternative treatments for uveitis. With the numerous choices belonging to different treatment modalities (conventional immunosuppressive agents
biologics and local drug delivery systems) on hand
the practice patterns have been reported to vary greatly from center to center. Factors influence uveitis specialists’ choices of immunosuppressive agents may be complex and may include personal familiarity
treatment availability
safety/tolerability
effectiveness
patient compliance
cost concerns and suggestions from related specialists such as rheumatologists and pediatricians. The focus of this review is to provide an overview of each treatment modality on safety/tolerability and effectiveness
which are believed to be the two most important factors affecting treatment decision making.
关键词
Keywords
references
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