Cyclosporine vs tacrolimus therapy for posterior and intermediate uveitis.
OBJECTIVE
To compare the efficacy and tolerability of tacrolimus and cyclosporine therapy for noninfectious posterior segment intraocular inflammation and to evaluate their effect on peripheral blood CD4(+) T-cell phenotype and activation status.


METHODS
Thirty-seven patients who required second-line immunosuppression for posterior segment intraocular inflammation were enrolled in this prospective randomized trial of tacrolimus vs cyclosporine therapy. The main outcome measures were visual acuity, binocular indirect ophthalmoscopy score, adverse effects, and quality of life. In addition, peripheral blood CD4(+) T-cell phenotype and activation status were evaluated by flow cytometry before treatment and at 2, 4, and 12 weeks using CD69, chemokine receptor (CCR4, CCR5, and CXCR3), and intracellular cytokine (tumor necrosis factor alpha, interferon-gamma, and interleukin 10) expression.


RESULTS
Thirteen patients (68%) taking tacrolimus and 12 patients (67%) taking cyclosporine responded to treatment. Cyclosporine therapy was associated with a higher incidence of reported adverse effects. Mean arterial pressure and serum cholesterol level were significantly higher at 3 months in the cyclosporine group than the tacrolimus group. No significant difference was detected with regard to effect on quality of life or CD4(+) T-cell phenotype.


CONCLUSIONS
Tacrolimus and cyclosporine were similar with regard to efficacy for posterior segment intraocular inflammation, but the results suggested a more favorable safety profile for tacrolimus therapy.
Murphy
Conor C
CC
Division of Ophthalmology, University of Bristol, Bristol Eye Hospital, Lower Maudlin Street, Bristol BS1 2LX, England.
Greiner
Kathrin
K
Plskova
Jarka
J
Duncan
Linda
L
Frost
N Andrew
NA
Forrester
John V
JV
Dick
Andrew D
AD
D000328:Adult; D015703:Antigens, CD / Q000378:metabolism; D000945:Antigens, Differentiation, T-Lymphocyte / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D002784:Cholesterol / Q000097:blood; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use*; D016207:Cytokines / Q000378:metabolism; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D016130:Immunophenotyping; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D037181:Lectins, C-Type; D008213:Lymphocyte Activation / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D015867:Uveitis, Intermediate / Q000188:drug therapy* / Q000276:immunology; D015866:Uveitis, Posterior / Q000188:drug therapy* / Q000276:immunology; D014792:Visual Acuity; D000099192:CD69 Antigens
D015703:Antigens, CD; D000945:Antigens, Differentiation, T-Lymphocyte; D002784:Cholesterol; D016572:Cyclosporine; D016207:Cytokines; D007166:Immunosuppressive Agents; D037181:Lectins, C-Type; D016559:Tacrolimus; D000099192:CD69 Antigens