Limited value of cyclosporine A for the treatment of patients with uveitis associated with juvenile idiopathic arthritis

Tappeiner, Christoph; Roesel, Martin; Heinz, Carsten; Michels, Hartmut; Ganser, Gerd; Heiligenhaus, Arnd (2009). Limited value of cyclosporine A for the treatment of patients with uveitis associated with juvenile idiopathic arthritis. Eye, 23(5), pp. 1192-1198. London: Nature Publishing Group 10.1038/eye.2008.174

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AIMS: Juvenile idiopathic arthritis (JIA) is often associated with severe chronic anterior uveitis (CAU), and immunosuppressive therapy may be required. In this study, the value of cyclosporine A (CsA) as monotherapy or as combination therapy for treating uveitis was studied in a large cohort of JIA children. METHODS: Multicentre retrospective study including 82 JIA children (girls n=60) suffering from unilateral or bilateral (n=55) CAU. The indication for CsA was active uveitis, although patients were on topical or systemic corticosteroids, MTX, or other immunosuppressive drugs. RESULTS: Inactivity of uveitis during the entire treatment period (mean 3.9 years) was obtained with CsA monotherapy in 6 of 25 (24%) patients, but more often when CsA was combined with the immunosuppressives (35/72 patients; 48.6%, P=0.037), or MTX (18/37 patients, 48.6%, P=0.065), which had already been given. With CsA (mean dosage 2.9 mg/kg), systemic immunosuppressive drugs and steroids could be reduced by >or=50% (n=19) or topical steroids reduced to <or=2 drops/eye/day (n=40) in selected patients. Pre-existing cystoid macular oedema did not resolve under CsA treatment in any of the patients. In nine patients (11%), CsA was discontinued because of systemic hypertension (n=1), elevated creatinine levels (n=3), or other adverse effects (n=5). CONCLUSIONS: These observations suggest that CsA has limited value as a second-line immunosuppressive drug for the treatment of JIA-associated CAU. The efficacy was better as the combination therapy in patients not responding to other immunosuppressives (eg, MTX) than the systemic monotherapy.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Ophthalmology
UniBE Contributor:	Tappeiner, Christoph
Subjects:	600 Technology > 610 Medicine & health
ISSN:	0950-222X
ISBN:	18551142
Publisher:	Nature Publishing Group
Language:	English
Submitter:	Christoph Tappeiner
Date Deposited:	04 Oct 2013 15:05
Last Modified:	05 Dec 2022 14:20
Publisher DOI:	10.1038/eye.2008.174
PubMed ID:	18551142
Web of Science ID:	000266023200033
URI:	https://boris.unibe.ch/id/eprint/28264 (FactScience: 119047)