Therapeutic strategy for the treatment of non-infectious uveitis proposed by an expert panel [Avis d'experts pour le traitement des uvéites non infectieuses]
Résumé
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). © 2018 Société Nationale Française de Médecine Interne (SNFMI)
Mots clés
macular edema
laser flare photometry
human
photometry
remission
multimodal imaging
adalimumab
azathioprine
corticosteroid
infliximab
interferon
methotrexate
mycophenolate mofetil
rapamycin
tocilizumab
Behcet disease
cancer recurrence
clinical evaluation
drug effect
drug indication
electroretinography
perimetry
Short Survey
treatment planning
uveitis