Anti-TNF therapies in the management of acute and chronic uveitis.
Patients with anterior uveitis may be treated with topical therapy alone but patients with posterior uveitis and those with sight threatening complications of anterior uveitis usually require systemic treatment especially if the disease is bilateral. The mainstay of treatment is corticosteroids and additional immunosuppressive agents such as cyclosporin and mycophenolate are used when necessary. There remains a significant cohort of patients in whom this therapy is either not tolerated or is ineffective. The use of the anti-tumour necrosis factor (TNF) antibodies has been very successful in controlling other immune-mediated disorders such as rheumatoid arthritis and has subsequently been extended to use in other arthritidies and other disorders such as psoriasis and Crohn's disease. TNF is known to play a key role in ocular inflammation as shown by animal studies and its detection in the ocular fluids of inflamed eyes in man. In some disorders all types of anti-TNF antibodies have similar efficacy but that does not appear to be the case with uveitis where infliximab is at present looking to be more effective than etanercept. The data on the use of anti-TNF drugs in uveitis is presented together with new data on its role as a steroid sparing agent.
Hale
Sarah
S
Department of Clinical Ophthalmology, Institute of Ophthalmology and Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK.
Lightman
Sue
S
D000328:Adult; D000818:Animals; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001168:Arthritis / Q000276:immunology / Q000628:therapy; D001528:Behcet Syndrome / Q000276:immunology / Q000628:therapy; D002675:Child, Preschool; D004195:Disease Models, Animal; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000276:immunology / Q000627:therapeutic use; D007167:Immunotherapy; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D013167:Spondylitis, Ankylosing / Q000276:immunology / Q000628:therapy; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology*; D014606:Uveitis, Anterior / Q000276:immunology / Q000473:pathology / Q000628:therapy; D015866:Uveitis, Posterior / Q000276:immunology / Q000473:pathology / Q000628:therapy
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab