[Therapeutic strategy for the treatment of non-infectious uveitis proposed by an expert panel]

E Diwo; P Sève; S Trad; P Bielefeld; D Sène; S Abad; A Brézin; P Quartier; I Koné Paut; M Weber; C Chiquet; M H Errera; J Sellam; P Cacoub; G Kaplanski; L Kodjikian; B Bodaghi; D Saadoun

doi:10.1016/j.revmed.2018.03.001

[Therapeutic strategy for the treatment of non-infectious uveitis proposed by an expert panel]

Rev Med Interne. 2018 Sep;39(9):687-698. doi: 10.1016/j.revmed.2018.03.001. Epub 2018 Mar 31.

[Article in French]

Authors

E Diwo¹, P Sève², S Trad³, P Bielefeld⁴, D Sène⁵, S Abad⁶, A Brézin⁷, P Quartier⁸, I Koné Paut⁹, M Weber¹⁰, C Chiquet¹¹, M H Errera¹², J Sellam¹³, P Cacoub¹⁴, G Kaplanski¹⁵, L Kodjikian¹⁶, B Bodaghi¹⁷, D Saadoun¹⁸

Affiliations

¹ Ophthalmology department, DHU ViewRestore, Pitié Salpêtrière hospital, Paris, France.
² Service de médecine interne, hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Faculté de médecine Lyon-Sud, université Claude Bernard-Lyon 1, France.
³ Service de médecine interne, hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France.
⁴ Internal medicine and systemic diseases department, médecine interne 2, university hospital Dijon Bourgogne, France; Service de médecine interne, hôpital Avicenne, Assistance publique-Hôpitaux de Paris (AP-HP), Bobigny, France; Faculté de médecine SMBH, université Paris 13, Sorbonne Paris Cité, Bobigny, France; UMR1125, LI2P, université Paris 13, Sorbonne Paris Cité, Bobigny, France.
⁵ Internal medicine department, Lariboisière hospital, AP-HP, Paris, France; Inserm UMR 1149, Paris Diderot university, Paris, France.
⁶ Service de médecine interne, hôpital Avicenne, Assistance publique-Hôpitaux de Paris (AP-HP), Bobigny, France; Faculté de médecine SMBH, université Paris 13, Sorbonne Paris Cité, Bobigny, France; UMR1125, LI2P, université Paris 13, Sorbonne Paris Cité, Bobigny, France.
⁷ Service d'ophtalmologie, hôpital Cochin, université Paris Descartes, Paris, France.
⁸ Unité d'immunologie-hématologie et rhumatologie pédiatriques, institut IMAGINE, centre de référence des maladies rhumatologiques inflammatoires et autoimmunes systémiques rares de l'enfant (RAISE), université Paris-Descartes university, hôpital Necker-Enfants-Malades, Assistance publique Hôpitaux de Paris, Paris, France.
⁹ Paediatric rheumatology department, centre de références des maladies autoinflammatoires et de l'amylose inflammatoire, CEREMAIA, university of Paris Sud, Bicêtre hospital, AP-HP, Paris, France.
¹⁰ Department of ophthalmology, Nantes university, Nantes university hospital, Nantes, France.
¹¹ Department of ophthalmology, Grenoble-Alpes university, Grenoble Alpes university hospital, Grenoble, France.
¹² Department of ophthalmology at Quinze-Vingts National Eye Hospital and DHU Sight Restore, Paris, France; Sorbonne universities, UPMC université Paris 06, Paris, France.
¹³ Service de rhumatologie, CRSA Inserm UMRS_938, DHU i2B, hôpital Saint-Antoine, Sorbonne Université, AP-HP, France.
¹⁴ Inflammation-immunopathology-biotherapy department (DHU i2B), Sorbonne universités, UPMC université Paris 06, UMR 7211, 75005 Paris, France; Inserm, UMR_S 959, 75013 Paris, France; CNRS, FRE3632, 75005 Paris, France; Department of internal medicine and clinical immunology, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Centre national de référence des maladies autoimmunes systémiques rares, centre National de référence des maladies autoinflammatoires et de l'amylose, France.
¹⁵ Service de médecine interne et immunologie clinique, Aix-Marseille université, hôpital de la conception, 147, boulevard Baille, 1305 Marseille, France.
¹⁶ Department of ophthalmology, Croix-Rousse university hospital, Hospices Civils de Lyon, university of Lyon I, 69004 Lyon, France; CNRS UMR 5510 Mateis, 69621 Villeurbanne, France.
¹⁷ Ophthalmology department, DHU ViewRestore, Pitié Salpêtrière hospital, Paris, France. Electronic address: [email protected].
¹⁸ Inflammation-immunopathology-biotherapy department (DHU i2B), Sorbonne universités, UPMC université Paris 06, UMR 7211, 75005 Paris, France; Inserm, UMR_S 959, 75013 Paris, France; CNRS, FRE3632, 75005 Paris, France; Department of internal medicine and clinical immunology, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Centre national de référence des maladies autoimmunes systémiques rares, centre National de référence des maladies autoinflammatoires et de l'amylose, France. Electronic address: [email protected].

PMID: 29610003
DOI: 10.1016/j.revmed.2018.03.001

Abstract

Conventional immunosuppressive drugs, anti-TNF alpha and other biotherapies used in clinical practice are capable of controlling non-infectious anterior uveitis, posterior uveitis and panuveitis. The present work has been led by a multidisciplinary panel of experts, internists, rheumatologists and ophthalmologists and is based on a review of the literature. In case of corticodependency or sight-threatening disease, conventional immunosuppressive drugs (methotrexate, azathioprine and mycophenolate mofetil) and/or anti-TNF alpha (adalimumab, infliximab) are used to achieve and maintain remission. Interferon is an efficient immunomodulatory treatment, as a second-line therapy, for some therapeutic indications (refractory macular edema, Behçet's vascularitis). Other biologics, especially tocilizumab, are showing promising results. Local treatments (corticosteroids, sirolimus etc.) are adjuvant therapies in case of unilateral inflammatory relapse. Therapeutic response must be evaluated precisely by clinical examination and repeated complementary investigations (laser flare photometry, multimodal imaging, perimetry, electroretinography measures).

Keywords: Anti-TNF alpha; Biotherapy; Biothérapie; Immunosuppresseurs; Immunosuppressors; Uveitis; Uvéite.

Publication types

Review

MeSH terms

Adrenal Cortex Hormones / therapeutic use
Antibodies, Monoclonal / therapeutic use
Biological Products / therapeutic use
Biological Therapy / methods
Expert Testimony
Humans
Immunosuppressive Agents / therapeutic use
Practice Guidelines as Topic* / standards
Tumor Necrosis Factor-alpha / immunology
Uveitis / therapy*

Substances

Adrenal Cortex Hormones
Antibodies, Monoclonal
Biological Products
Immunosuppressive Agents
Tumor Necrosis Factor-alpha