Microsoft powerpoint - new drugs for uveitis [compatibility mode]

Cytotoxic T
PG’s. LTB4
response
- Anti- IL 1 receptor antagonist (Anakinra)- recombinant IL 2- recombinant IL 12- combinations of the above • Very few randomised studies• Most concentrate on not responded to conventional immunosuppression • Few studies concentrate specifically on CMO• Effects are often short term and antibodies to • Monoclonal against TNFα• Best studied for various • Rapid onset of action but tends to fail long • Proven efficacy in Behcet’s disease• Extremely useful in JIA • Usuall • 23 patients, all refractory to steroids and 1 • 18/23 clinical success at 10 weeks• 11/23 h • 7/14 still successful at 1 year• Hi h • Drug induced lupus• Tuberculosis• Cong • Soluble TNF receptor • Generally not as • Little information in its possible role in CMO • Recombinant non-glycosylated homologue of human • Competitively inhibits binding of IL-1α and IL-1β to • Used in refractory rheumatoid and polychondritis • Single case report in recalcitrant uveitis associated • Uveitis and disc swelling improved with lack of relapse of ocular disease but no details on use for • Binds IL-2 receptor on activated T cells• Case series have suggested that it may have a role in the treatment of refractory uveitis (intermediate, Behcet’s and birdshot). No serious adverse events • 1 RCT of systemic immunosuppression and daclizumab versus placebo showed no benefit in • Main outcomes have been reduction in • No trials or reports have mentioned effect on CMO • Targets B cell antigen, CD 20• Selective and • Single case report in patient with chronic AU and immunosuppression (steroids, ciclosporin methotrexate, cellcept), had a 12 month remission after a single course • Cytokine belonging to type 1 interferons• Has a number of antiviral,antiproliferative, antiangiogenic and immunomodulatory effects anti-inflammatory as it works in quiet eyes flu like symptoms, depression, alopecia and may develop a • 50 patients with non-responsive ocular BD• Relapse when • 93% response rate• Full remission by week 24• 40% off • Chronic CMO (all>24 months) refractory to • Effect apparent within 3 days• Recurrence requiring retreatment was common • 13 patients, all with intermediate uveitis• All needed >10mg prednisolone to control their • Treated with Interferon β 1a for 24 months• CMO resol d • At end of study 9 patients off steroids and the rest • Increased VEGF in aqueous of patients with uveitis • 13 patients with controlled uveitis but persistent CMO (nb 9/11 no response to periocular/intravitreal steroid) • Cumulative probability of improved VA at 14 weeks • Effect limited as lasts only 6-8 weeks • Campath-1 is a humanised moab against • 10 patients refractory to all treatment• All showed initial improvement• Minimal toxicity• Remission in 8 (follow-u • 10 patients (idiopathic, birdshot, Behcet’s, • IVIG given 3infusions daily per month• 5/10 patients showed sustained recovery• Did not • 18 patients• 17/23 eyes showed FFA improvement in CMO• 9/23 eyes • New anti TNF agents (?amazimab, gorblimeycept) • Refinement of interferon alpha• Biological combination therapy• Tailoring according • Long acting intravitreal agents• Enhancement of immunosuppression using homologous anti CD-25 (patient’s own T regs)

Source: http://www.mosuk.co.uk/pdfs/12.10%20New%20drugs%20for%20uveitis.pdf