4.4 Review

Systematic Review on the Effectiveness of Immunosuppressants and Biological Therapies in the Treatment of Autoimmune Posterior Uveitis

Journal

SEMINARS IN ARTHRITIS AND RHEUMATISM
Volume 40, Issue 4, Pages 314-323

Publisher

W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.semarthrit.2010.05.008

Keywords

uveitis; cystoid macular edema; effectiveness; immunosuppressants; biological therapies

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Objectives: 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 Behcet'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 Behcet and etanercept) may be effective in autoimmune uveitis and macular edema. No superiority may be inferred from this review. (C) 2011 Elsevier Inc. All rights reserved. Semin Arthritis Rheum 40:314-323

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