Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


Are Azathioprine, Cyclophosphamide and Chlorambucil Effective for the Treatment of NON Infectious Autoimmune Uveitis? A Systematic Literature Review

Pato1,  Esperanza, Ortiz2,  Ana M., Abad3,  Miguel, Carmona4,  Loreto, Loza4,  Estibaliz, Maese4,  Jesús, Munoz-Fernandez5,  Santiago

Hospital Clínico San Carlos, Madrid, Spain,
Hospital de la Princesa, Madrid, Spain,
Caceres, Spain,
Fundación Española de Reumatología, Madrid, Spain,
Madrid, Spain,
Rheumatology Section, Hospital Doctor Negrin, Las Palmas de Gran Canaria, Spain

Non infectious autoinmune uveitis (NIAU) might develop a severe course with poor visual prognosis if an adequate control of the disease is not achieved. The treatment of autoimmune uveitis are corticosteroids and immunossupressive agents (IS). Azathioprine (AZA), cylophospamide (CY) and chlorambucil (CB), are IS used for the treatment of these uveitis.

Purpose:

To systematically review the published evidence regarding the efficacy of AZA, CY and CB in NIAU.

Method:

Systematic review of studies retrieved by a sensitive search strategy in Medline, Embase and Cochrane Library, up to October 2007. Randomized controlled trials, observational studies and case series were included. Selection criteria: population: patients with NIAU (intermediate, posterior and panuveitis); intervention: studies had to test cyclosporine A, tacrolimus, sirolimus, methotrexate, mycophenolate mofetil, AZA CY and CB; outcomes: visual acuity, Tyndall, vitreous haze, retinal vasculitis, macular edema, pars planitis and adverse events. Three reviewers screened the titles and abstracts of the retrieved articles for selection criteria independently and collected the data by using ad hoc standard forms. One of them also graded the quality of the selected studies using a modification of the Oxford Centre for Evidence-based Medicine Levels of Evidence in its May 2001 update.

Results:

A total of 128 articles were studied in detail, of which 39 were studies of NIAU with AZA, CY or CB. 13 studies were excluded (literature review, combined treatment), and 26 were included (2 randomized controlled trials, 1 clinical trial, 5 prospective studies,18 retrospective case series). A total of 443 patients with NIAU were analyzed (associated with Beçhet disease, Vogt-Koyanagi-Harada, serpiginous choroiditis, sympathetic ophthalmia and other diagnosis). in spite of the great variability regarding the study design, study samples, treatment duration and outcomes, most patients on AZA, CY or CB showed an stabilization or improvement in the visual outcomes. Minor adverse events were reported.

Conclusion:

Treatment with AZA is effective and safe in the treatment of patients with Behçet associated uveitis (level of evidence 1A, grade of recommendation A), and is effective and safe for the treatment of NIAU (level of evidence 4, grade of recommendation C).

Treatment with CY and CB are effective and safe in the treatment of NIAU (level of evidence 4, grade of recommendation C).

To cite this abstract, please use the following information:
Pato, Esperanza, Ortiz, Ana M., Abad, Miguel, Carmona, Loreto, Loza, Estibaliz, Maese, Jesús, et al; Are Azathioprine, Cyclophosphamide and Chlorambucil Effective for the Treatment of NON Infectious Autoimmune Uveitis? A Systematic Literature Review [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1479
DOI: 10.1002/art.26553

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