Lavnish Joshi1, Lazha Talat1, Satish Yaganti2, Sartaj Sandhu3, Simon R J Taylor4, Denis Wakefield5, Peter McCluskey3, Susan Lightman6. 1. Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom. 2. Royal Surrey County Hospital, Guildford, United Kingdom. 3. Save Sight Institute, Sydney Eye Hospital, Sydney, Australia. 4. Royal Surrey County Hospital, Guildford, United Kingdom; Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom. 5. School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia. 6. Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom. Electronic address: s.lightman@ucl.ac.uk.
Abstract
PURPOSE: To evaluate the outcomes of changing immunosuppressive therapy for noninfectious uveitis after failure. DESIGN: Retrospective cohort study. PARTICIPANTS: Patients with noninfectious uveitis managed at 2 tertiary uveitis clinics in the United Kingdom and Australia. METHODS: Participants with a history of using immunosuppressive therapy were identified in clinics, and notes were reviewed by doctors trained in uveitis therapy. Each treatment episode/course (starting or changing a therapy) was identified, and demographic details, clinical characteristics, drug used (second-line immunosuppressive agent [ISA] or biologicals), and drug doses were obtained. MAIN OUTCOME MEASURES: For each treatment episode, the reasons for changing therapy, corticosteroid-sparing effects, and control of inflammation were determined. RESULTS: A total of 147 patients were identified who underwent 309 different treatment episodes. Fifty-five percent of patients eventually required a change in treatment after their first treatment episode/course. Forty-five episodes involved switching from one ISA to another, with 50% to 100% of these patients achieving "success" (prednisolone ≤10 mg and sustained control) with the new ISA. A combination of ISAs were used in 53 episodes, with "success" being achieved in 50% to 71% of these patients. Biological agents were used in 45 episodes, the most common one being infliximab, which achieved success in 80% of patients. CONCLUSIONS: Our data suggest that control of inflammation can be achieved after switching or combining ISAs.
PURPOSE: To evaluate the outcomes of changing immunosuppressive therapy for noninfectious uveitis after failure. DESIGN: Retrospective cohort study. PARTICIPANTS: Patients with noninfectious uveitis managed at 2 tertiary uveitis clinics in the United Kingdom and Australia. METHODS: Participants with a history of using immunosuppressive therapy were identified in clinics, and notes were reviewed by doctors trained in uveitis therapy. Each treatment episode/course (starting or changing a therapy) was identified, and demographic details, clinical characteristics, drug used (second-line immunosuppressive agent [ISA] or biologicals), and drug doses were obtained. MAIN OUTCOME MEASURES: For each treatment episode, the reasons for changing therapy, corticosteroid-sparing effects, and control of inflammation were determined. RESULTS: A total of 147 patients were identified who underwent 309 different treatment episodes. Fifty-five percent of patients eventually required a change in treatment after their first treatment episode/course. Forty-five episodes involved switching from one ISA to another, with 50% to 100% of these patients achieving "success" (prednisolone ≤10 mg and sustained control) with the new ISA. A combination of ISAs were used in 53 episodes, with "success" being achieved in 50% to 71% of these patients. Biological agents were used in 45 episodes, the most common one being infliximab, which achieved success in 80% of patients. CONCLUSIONS: Our data suggest that control of inflammation can be achieved after switching or combining ISAs.
Authors: Timothy Lee Tang Lee Say; Verlyn Yang; Jacob M Fingret; Sophia Zagora; Richard Symes; Christine Younan; Elisa Eleanor Cornish; Nitin Verma; Anthony Sammel; Denis Wakefield; Deborah Speden; Peter J McCluskey Journal: BMJ Open Ophthalmol Date: 2021-09-27
Authors: Ana Belen Rivas; Amanda Lopez-Picado; Valentina Calamia; Ester Carreño; Lidia Cocho; Miguel Cordero-Coma; Alex Fonollosa; Felix M Francisco Hernandez; Angel Garcia-Aparicio; Javier Garcia-Gonzalez; Jose Juan Mondejar; Leticia Lojo-Oliveira; Llucí Martínez-Costa; Santiago Munoz; Diana Peiteado; Jose Antonio Pinto; Beatriz Rodriguez-Lozano; Esperanza Pato; David Diaz-Valle; Elena Molina; Luis Alberto Tebar; Luis Rodriguez-Rodriguez Journal: BMJ Open Date: 2022-03-22 Impact factor: 2.692