This article is more than 5 years old. Information may no longer be current.
No one answer for ocular inflammation management
Click Here to Manage Email Alerts
LONDON — Older therapies to treat uveitis, such as rimexolone or prostaglandins, are still useful for some patients, but others may benefit from newer therapies such as intravitreal triamcinolone, said Susan Lightman, FRCOphth, PhD, of Moorfields Eye Hospital.
Dr. Lightman described a number of new therapies for uveitis, their indications and drawbacks, at the Moorfields Bicentenary scientific meeting here.
Steroid use for the management of uveitis can result in steroid-induced osteoporosis, Dr. Lightman said, so for those who may be at risk Fosamax (alendronate sodium, Merck) is prescribed once a week in addition to the steroid. Ptosis may be “more of a problem with triamcinolone,” she said, but the efficacy of the drug is comparable to that of older treatments.
Mycophenolate has shown similar results to azathioprine, “but it’s not effective without steroid use as well,” she said. With both drugs, a low lymphoma rate has been reported in the literature.
New drugs called anti-tumor-necrosis factors, infliximab and etanercept, are available to manage inflammation, but infliximab is costly at around $5,000 per dose, Dr. Lightman said. In addition, patients who receive infliximab “may be at a higher risk for tuberculosis and multiple sclerosis,” she said, and the long-term risks for lymphoma are unknown.
A study of intravitreal triamcinolone showed that patients between the ages of 20 and 39 years had “significant” IOP elevations, while those over 70 years and pediatric patients had no IOP rise, she said.
Interferon-alpha is a promising new treatment as well, Dr. Lightman said. Long-term results at more than 3 years follow-up indicate there are some side effects, she said, and the expense must be considered as well.