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Immune modulation in uveitis:Biologicals ‐ [bdquo]Golden calf“ or [bdquo]Gold Standard“?
Author(s) -
BODAGHI B
Publication year - 2011
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2011.3442.x
Subject(s) - uveitis , medicine , etanercept , adalimumab , rheumatoid arthritis , adverse effect , immunology
Uveitis is a sight‐threatening auto‐immune condition. Most of the cases require corticosteroids and conventional immunosuppressors. Until recently, safety issues limited the use of new therapeutic strategies such as biological agents. Anti‐TNF alpha and interferon alpha are the two major drugs, used for more than 12 years with well‐defined results and side‐effects. Behçet's disease is the principal indication of biologicals with a dramatic improvement of uveitis and a long‐lasting remission. Dosing and duration remain controversial. Anti‐TNF alpha are used in severe cases with a direct visual threat. The intravitreal use of the drug seems to be inefficient. Interestingly, other molecules such as anti‐IL1 molecules did not show a significant control of uveitis in a randomized multicentre clinical trial. Refractory cases of JIA‐associated uveitis are another indication of anti‐TNF alpha drugs. Even though, etanercept is highly effective on the rheumatological component of the disease, it is ineffective on uveitis. On the other hand, adalimumab is effective on uveitis but less commonly on arthritis. In the future, we will probably welcome new types of biologicals agents in the field of uveitis. However, it seems paramount to determine the best route and rhythm of administration, dosages and duration of therapy. Side effects are also important to consider before any further conclusions, especially in children.