Systematic review on the effectiveness of immunosuppressants and biological therapies in the treatment of autoimmune posterior uveitis.
OBJECTIVE
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.
Pato
Esperanza
E
Rheumatology Department, Hospital Clínico San Carlos, Madrid, Spain. epato.hcsc@salud.madrid.org
Muñoz-Fernández
Santiago
S
Francisco
Félix
F
Abad
Miguel A
MA
Maese
Jesús
J
Ortiz
Ana
A
Carmona
Loreto
L
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000628:therapy; D001327:Autoimmune Diseases / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008269:Macular Edema / Q000628:therapy; D016896:Treatment Outcome; D014606:Uveitis, Anterior / Q000628:therapy; D015866:Uveitis, Posterior / Q000628:therapy*
D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents