Seminars in Arthritis and Rheumatism
Volume 40, Issue 4 , Pages 314-323, February 2011

Systematic Review on the Effectiveness of Immunosuppressants and Biological Therapies in the Treatment of Autoimmune Posterior Uveitis

  • Esperanza Pato, MD

      Affiliations

    • Rheumatology Department, Hospital Clínico San Carlos, Madrid, Spain
    • Corresponding Author InformationAddress reprint requests to Dra. Esperanza Pato, Servicio de Reumatología, Hospital Clínico San Carlos, Calle Martín Lagos, s/n, 28043 Madrid, Spain
    • ,
  • Santiago Muñoz-Fernández, MD, PhD

      Affiliations

    • Rheumatology Department, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
    • ,
  • Félix Francisco, MD

      Affiliations

    • Rheumatology Department, Hospital Dr. Negrín, Las Palmas de Gran Canaria, Spain
    • ,
  • Miguel A. Abad, MD

      Affiliations

    • Rheumatology Department, Hospital Virgen del Puerto, Plasencia, Spain
    • ,
  • Jesús Maese, MD

      Affiliations

    • Grupo SER de revisores, Madrid, Spain
    • ,
  • Ana Ortiz, MD, PhD

      Affiliations

    • Rheumatology Department, Hospital de la Princesa, Madrid, Spain
    • ,
  • Loreto Carmona, MD, PhD

      Affiliations

    • Research Unit, Sociedad Española de Reumatología, Madrid, Spain
    • ,
  • Uveitis Working Group from Spanish Society of Rheumatology

published online 26 July 2010.

Objectives

To analyze the effectiveness of immunosuppressants and biological therapies in autoimmune posterior uveitis, chronic anterior uveitis associated with juvenile idiopathic arthritis, and macular edema.

Methods

Systematic review. We conducted a sensitive literature search in Medline (from 1961) and EMBASE (from 1980) until October 2007. Selection criteria were as follows: (1) population: autoimmune posterior uveitis, chronic anterior uveitis in juvenile idiopathic arthritis, and macular edema; (2) intervention: immunosuppressive and biologic therapies; (3) outcomes: visual acuity, Tyndall, vitreous haze, macular edema, pars planitis, and retinal vasculitis. There were no limitations regarding study design. The quality of each study was evaluated using the Jadad's scale and Oxford Levels of Evidence.

Results

Two hundred sixty-five articles were selected for detailed review of the 4235 found in the initial search: 128 records were on immunosuppressants, 105 on biological therapies, and 32 on macular edema. Overall, both the immunosuppressive and the biologic therapies appeared effective in the treatment of autoimmune posterior uveitis, except for daclizumab in uveitis related to Behçet's disease, and for etanercept in any uveitis. In the treatment of macular edema, the drugs tested were also effective.

Conclusions

Based on the evidence collated, immunosuppressants and biological therapies (except for daclizumab in Behçet and etanercept) may be effective in autoimmune uveitis and macular edema. No superiority may be inferred from this review.

Keywords: uveitis, cystoid macular edema, effectiveness, immunosuppressants, biological therapies

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 Sources of support: Schering Plough, S.A. donated to the Fundación Española de Reumatología to facilitate the review. The Fundación Española de Reumatología provided the personal resources and materials needed for the review.

 The panel of experts of the Uveitis Working Group from the Spanish Society of Rheumatology include the following: David Diaz Valle, MD, PhD; Ma Cruz Fernández Espartero, MD; Jose A. Fernández Sánchez, MD; Angel García Aparício, MD; Estibaliz Loza Santamaría, MD; Roberto Miguelez Sánchez, MD; Carlos Montilla Morales, MD; and Eduardo Úcar Ângulo, MD.

PII: S0049-0172(10)00084-3

doi:10.1016/j.semarthrit.2010.05.008

Seminars in Arthritis and Rheumatism
Volume 40, Issue 4 , Pages 314-323, February 2011

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