Klin Monbl Augenheilkd 2018; 235(05): 562-567
DOI: 10.1055/a-0586-3931
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Konventionelle synthetische Immunsuppressiva (DMARDs) für die Therapie der nichtinfektiösen Uveitis

Conventional Synthetic Disease-modifying Antirheumatic Drugs (DMARDs) for the Treatment of Non-infectious Uveitis
Christoph Tappeiner
1   Universitätsklinik für Augenheilkunde, Inselspital, Bern, Schweiz
,
Thomas Rath
2   1. Medizinische Klinik, St. Franziskus-Hospital, Münster
,
Arnd Heiligenhaus
3   Augenabteilung, St. Franziskus-Hospital, Münster
› Author Affiliations
Further Information

Publication History

eingereicht 23 December 2017

akzeptiert 26 February 2018

Publication Date:
08 May 2018 (online)

Zusammenfassung

Die Initialtherapie von Uveitiden besteht aus einer topischen und/oder systemischen Kortikosteroidgabe. Zur Erzielung von dauerhafter Reizfreiheit, Prophylaxe von uveitischen Sekundärkomplikationen, Kortisoneinsparung und Vermeidung von kortikosteroidbedingten unerwünschten Arzneimittelwirkungen ist im weiteren Verlauf nicht selten der Einsatz einer krankheitsmodifizierenden Therapie (sog. disease modifying antirheumatic drugs, DMARDs) notwendig. Dieser Beitrag soll eine strukturierte Übersicht über die wichtigsten konventionellen synthetischen DMARDs, deren Indikation, mögliche unerwünschte Arzneimittelwirkungen und das interdisziplinäre Monitoring vermitteln.

Abstract

The first-line therapy of uveitis normally consists of topical and/or systemic corticosteroid use. To achieve long-term ocular quiescence, to prevent uveitic secondary complications, to allow corticosteroid sparing and to avoid corticosteroid-related adverse effects, the application of immunosuppressive drugs (disease modifying antirheumatic drugs; DMARDs) is often necessary during the course of the disease. This article presents a structural overview of the most important conventional synthetic DMARDs, their indication, adverse events and interdisciplinary monitoring.

 
  • Literatur

  • 1 Jabs DA, Rosenbaum JT, Foster CS. et al. Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel. Am J Ophthalmol 2000; 130: 492-513
  • 2 Jabs DA. Immunosuppression for the uveitides. Ophthalmology 2018; 125: 193-202 doi:10.1016/j.ophth.2017.08.007
  • 3 Wakefield D, McCluskey P, Wildner G. et al. Inflammatory eye disease: Pre-treatment assessment of patients prior to commencing immunosuppressive and biologic therapy: Recommendations from an expert committee. Autoimmun Rev 2017; 16: 213-222
  • 4 Lee RWJ, Schewitz LP, Nicholson LB. et al. Steroid refractory CD4+ T cells in patients with sight-threatening uveitis. Invest Ophthalmol Vis Sci 2009; 50: 4273-4278
  • 5 Jabs DA, Rosenbaum JT. Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel. Am J Ophthalmol 2001; 131: 679
  • 6 Wakefield D, Herbort CP, Tugal-Tutkun I. et al. Controversies in ocular inflammation and immunology laser flare photometry. Ocul Immunol Inflamm 2010; 18: 334-340
  • 7 Cordero-Coma M, Salazar-Méndez R, Yilmaz T. Treatment of severe non-infectious uveitis in high-risk conditions (Part I): pregnancy and malignancies, management and safety issues. Expert Opin Drug Saf 2015; 14: 1071-1086
  • 8 Kruh J, Foster CS. Corticosteroid-sparing agents: conventional systemic immunosuppressants. Dev Ophthalmol 2012; 51: 29-46
  • 9 Pasadhika S, Kempen JH, Newcomb CW. et al. Azathioprine for ocular inflammatory diseases. Am J Ophthalmol 2009; 148: 500-509.e2
  • 10 Kaçmaz RO, Kempen JH, Newcomb C. et al. Cyclosporine for ocular inflammatory diseases. Ophthalmology 2010; 117: 576-584
  • 11 Pujari SS, Kempen JH, Newcomb CW. et al. Cyclophosphamide for ocular inflammatory diseases. Ophthalmology 2010; 117: 356-365
  • 12 Lee K, Bajwa A, Freitas-Neto CA. et al. A comprehensive review and update on the non-biologic treatment of adult noninfectious uveitis: part I. Expert Opin Pharmacother 2014; 15: 2141-2154
  • 13 Simonini G, Cimaz R, Jones GT. et al. Non-anti-TNF biologic modifier drugs in non-infectious refractory chronic uveitis: The current evidence from a systematic review. Semin Arthritis Rheum 2015; 45: 238-250
  • 14 Jabs DA, Nussenblatt RB, Rosenbaum JT. et al. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol 2005; 140: 509-516
  • 15 Goyal A, Goyal K, Merola JF. Screening and vaccinations in patients requiring systemic immunosuppression: an update for dermatologists. Am J Clin Dermatol 2015; 16: 179-195
  • 16 Warnatz K, Goldacker S, Gause AM. et al. [Vaccination recommendations of the Commission for Pharmacotherapy of the German Society of Rheumatology]. Z Rheumatol 2013; 72: 687-689
  • 17 Wakefield D. Does cyclophosphamide still have a role in the treatment of severe inflammatory eye disease?. Ocul Immunol Inflamm 2014; 22: 306-310
  • 18 Joshi L, Talat L, Yaganti S. et al. Outcomes of changing immunosuppressive therapy after treatment failure in patients with noninfectious uveitis. Ophthalmology 2014; 121: 1119-1124
  • 19 Kempen JH, Daniel E, Dunn JP. et al. Overall and cancer related mortality among patients with ocular inflammation treated with immunosuppressive drugs: retrospective cohort study. BMJ 2009; 339: b2480
  • 20 Østensen M, Förger F. Management of RA medications in pregnant patients. Nat Rev Rheumatol 2009; 5: 382-390
  • 21 Götestam Skorpen C, Hoeltzenbein M, Tincani A. et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis 2016; 75: 795-810
  • 22 Viktil KK, Engeland A, Furu K. Outcomes after anti-rheumatic drug use before and during pregnancy: a cohort study among 150,000 pregnant women and expectant fathers. Scand J Rheumatol 2012; 41: 196-201
  • 23 Götestam Skorpen C, Lydersen S, Gilboe IM. et al. Disease activity during pregnancy and the first year postpartum in women with systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2017; 69: 1201-1208
  • 24 Flint J, Panchal S, Hurrell A. et al. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford) 2016; 55: 1693-1697
  • 25 Simonini G, Bracaglia C, Cattalini M. et al. Predictors of relapse after discontinuing systemic treatment in childhood autoimmune chronic uveitis. J Rheumatol 2017; 44: 822-826
  • 26 Burmester GR, Kivitz AJ, Kupper H. et al. Efficacy and safety of ascending methotrexate dose in combination with adalimumab: the randomised CONCERTO trial. Ann Rheum Dis 2015; 74: 1037-1044