Uveitis
Conditions
Keywords
Uveitis idiopatic (except anterior), azathioprine, methotrexate
Brief summary
Retrospective study at the Brest universitary hospital to evaluate the efficacy of methotrexate (MTX) and azathioprine (AZA) in background treatment of unidentified non anterior uveitis.
Detailed description
Uveitis is a major cause of ocular damage, responsible for 5 to 10% of blindness in the world. More broadly, up to 35% of patients with uveitis have visual acuity impairment ranging from significant to legal blindness \[4\]. The figures of legal blindness up to 25% according to the studies The objective of any anti-inflammatory therapy strategy for uveitis is to: * Quickly control eye inflammation to minimize irreversible structural damage and maintain visual function. * Prevent inflammatory recurrences, which cause complications and co-morbidity. * Limit the use of systemic corticosteroids over the course of their deleterious metabolic effects. * Optimize the risk-benefit balance and promote compliance. The studies concerning uveitis linked with another disease are multiple and are therefore well documented. Uveitis of undetermined origin is classified, by definition, as uveitis of non-infectious origin. Anterior uveitis are available for local treatment prior to any discussion of introducing systemic treatment. Intermediate uveitis, posterior and panuveitis justify systemic treatment. Systemic treatments used in these uveitis are METHOTREXATE, AZATHIOPRINE, MYCOPHENOLATE MOFETIL CICLOSPORINE, INTERFERON ALPHA, anti-TNF alpha. Antimetabolites (azathioprine, mycophenolate mofetil and methotrexate) are the most commonly used immunosuppressants. Several randomized studies (retrospective or prospective) compared the use of METHOTREXATE (MTX) and MYCOPHENOLATE MOFETIL (MMF), in the management of non-infectious inflammatory ocular disease as a corticosteroid-sparing treatment. Although MMF has a faster response time compared to MTX for inflammation control, the success rate is equivalent. These studies found no superiority of one molecule over the other . There are no studies in the literature comparing the use of MTX versus AZA in treatment of these non-prior uveitis of undetermined origin. These two molecules are frequently used in our center as first-line treatment of idiopathic uveitis in an undifferentiated way. The objective of this study is therefore to determine whether one of these molecules should be preferred for the management of our patients.
Interventions
None listed
Sponsors
University Hospital, Brest
Study design
Observational model
CASE_CONTROL
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patient age\>18 years * Intermediate, posterior or panuveitis diagnosed clinically by an ophthalmologist. * Patient treated with azathioprine or methotrexate
Exclusion criteria
* Patient under legal protection * Methotrexate dose \< 10mg or azathioprine \< 50mg * Systemic or ophthalmological disease (Behçet, sarcoidosis, Retinopathy of Birdshot, etc.) * Infectious uveitis * Ophthalmological surgery \< 30 days * Delayed corticosteroid ocular implant \> 3 months * Introduction of biotherapy simultaneously or prior to immunosuppressive treatment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| To compare the effectiveness of methotrexate versus azathioprine in controlling the inflammation of intermediate, posterior and panuveitis of undetermined origin. | one year | The main evaluation criterion will be the 12-month treatment effectiveness characterized by: * No recurrence of inflammation in both eyes as assessed by the patient's referring ophthalmologist * Oral corticosteroids \<7.5 mg equivalent-prednisone * No re-establishment of local corticosteroid therapy \> or = at 2 drop/d * No treatment stop due to intolerance or adverse reaction. |
Countries
France
Contacts
Primary ContactBénédicte ROUVIERE, PhD
Backup ContactXavier SAVARY
Outcome results
None listed