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June 8, 2009

Uncovering the Risks of Immunosuppressive Therapy in Patients With Uveitis

Arch Ophthalmol. 2009;127(6):799-800. doi:10.1001/archophthalmol.2009.124

The systemic treatment of potentially blinding ocular inflammatory disease is fraught with challenges, ranging from lack of efficacy to serious safety concerns. Systemic corticosteroids, which have been used since the 1950s, have a host of potential adverse effects. Steroid-sparing agents such as methotrexate, azathioprine, and mycophenolate may reduce the need for corticosteroids, but carry with them their own set of adverse effects, and may be of limited efficacy in some cases. The biologic agents, including the tumor necrosis factor (TNF) inhibitors, have been more recently introduced and are being used with increasing frequency. The TNF inhibitor infliximab has been reported in case series and retrospective studies as effective in managing treatment-resistant ocular inflammation.1-3 Adverse effects have been reported as minimal in most series in the uveitis literature,3-5 but more significant in the rheumatologic literature.6-8 The adverse effect profile of infliximab, as with most agents, seems better with shorter reported follow-up.

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