Información del artículo
Resumen
La uveítis es responsable de la pérdida visual hasta del 10% de la población mundial y es la segunda causa de ceguera tratable en personas de edad productiva, después de la retinopatía diabética. El tratamiento de la uveítis no infecciosa depende de su severidad; existe un alto porcentaje (hasta el 40%) de casos refractarios a inmunosupresores y esteroides a dosis altas. El factor de necrosis tumoral (TNF) es una citoquina fundamental en la patogénesis de la uveítis no infecciosa; su bloqueo selectivo con anticuerpos monoclonales y proteínas de fusión ha demostrado, en series de casos, estudios abiertos y pequeños estudios clínicos aleatorizados, eficacia y seguridad en casos idiopáticos y asociados a enfermedades autoinmunes, en la prevención de recaídas, ahorro de esteroides y pronóstico visual a largo plazo. Sin embargo, se han descrito efectos paradójicos, como la inducción de uveítis asociada al uso de proteínas de fusión contra TNF, como etanercept. Se pretende hacer una revisión exhaustiva de la literatura para determinar el papel de los agentes anti-TNF en el tratamiento de la uveítis no infecciosa refractaria.
Palabras clave:
uveítis
infliximab
adalimumab
proteína de fusión TNFR-Fc
Summary
Uveitis is responsible for visual loss of up to 10% of world population and is the second leading cause of treatable blindness in people of working age, after diabetic retinopathy. The treatment of noninfectious uveitis depends on its severity; there is a high percentage (up to 40%) of cases refractory to immunosuppressants and high-dose corticosteroids. Tumor necrosis factor (TNF) is a key cytokine in the pathogenesis of noninfectious uveitis. Several case reports, open trials and small randomized controlled trials with selective blocking of TNF with monoclonal antibodies (infliximab and adalimumab) and fusion proteins (etanercept) have shown efficacy in the treatment of refractory uveitis, in idiopathic and associated with autoimmune diseases, in preventing relapses, steroid-sparing effect and improvement of long-term visual prognosis. However, there are some reports of paradoxical effects, such as induction of uveitis associated with the use of etanercept. We performed a thorough review of the literature to determine the role of anti-TNF agents in the treatment of refractory non-infectious uveitis.
Key words:
Uveitis
infliximab
adalimumab
TNFR-Fc fusion protein
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Bibliografía
[1.]
R.W. Read, Uveitis.
advances in understanding of pathogenesis and treatment.
Curr Rheumatol Rep, 8 (2006), pp. 260-266
[2.]
I. Tugal-Tutkun, K. Havrlikova, W.J. Power, C.S. Foster.
Changing patterns in uveitis of childhood.
Ophthalmology, 103 (1996), pp. 375-383
[3.]
D.A. Jabs, R.B. Nussenblatt, J.T. Rosenbaum, The Standardization of Uveitis Nomenclature (SUN) Working Group.
Standardization of Uveitis Nomenclature for Reporting Clinical Data. Results of the First International Workshop.
Am J Ophthalmol, 140 (2005), pp. 509-516
[4.]
C.A. McCannel, G.N. Holland, C.J. Helm, P.J. Cornell, J.G. Winston, T.G. Rimmer, UCLA Community-Based Uveitis Study Group.
Causes of uveitis in the general practice of ophthalmology.
Am J Ophthalmol, 121 (1996), pp. 35-46
[5.]
B. Bodaghi, N. Cassoux, B. Wechsler, D. Hannouche, C. Fardeau, T. Papo, et al.
Chronic severe uveitis: Etiology and visual outcome in 927 patients from a single center.
Medicine, 80 (2001), pp. 263-270
[6.]
P.G. Theodossiadis, N.N. Markomichelakis, P.P. Sfikakis.
Tumor necrosis factor antagonists: preliminary evidence for an emerging approach in the treatment of ocular inflammation.
Retina, 27 (2007), pp. 399-413
[7.]
V.K. Singh, G. Rai.
Cytokines in posterior uveitis: An update.
Immunol Res, 23 (2001), pp. 59-74
[8.]
T.K. Khera, A.D. Dick, L.B. Nicholson.
Mechanisms of TNF?. regulation in uveitis: Focus on RNA-binding proteins.
Prog Retin Eye Res, 29 (2010), pp. 610-621
[9.]
V.K. Gullapalli, D.S. Chu.
Use of Tumor Necrosis Factor- ?.
Inhibitors in Treatment Of Noninfectious Autoimmune Uveitis. Comtemporary Ophthalmol, 7 (2008), pp. 1-8
[10.]
M.J. Lustig, E.T. Cunningham Jr..
Use of immunosuppressive agents in uveitis.
Curr Opin Ophthalmol, 14 (2003), pp. 399-412
[11.]
A. Joseph, D. Raj, H.S. Dua, P.T. Powell, P.C. Lanyon, R.J. Powell.
Infliximab in the treatment of refractory posterior uveitis.
Ophthalmology, 110 (2003), pp. 1449-1453
[12.]
P.P. Sfikakis, P.G. Theodossiadis, C.G. Katsiari, P. Kaklamanis, N.N. Markomichelakis.
Effect of infliximab onsight-threatening panuveitis in Behçet's disease.
Lancet, 358 (2001), pp. 295-296
[13.]
W. Fries, M.R. Giofre, M. Catanoso, R. Lo Gullo.
Treatment of acute uveitis associated with Crohn's disease and sacroileitis with infliximab.
Am J Gastroenterol, 97 (2002), pp. 499-500
[14.]
B. Bodaghi, E. Bui Quoc, B. Wechsler, T.H. Tran, N. Cassoux, D. Le Thi Huong, et al.
Therapeutic use of infliximab in sight threatening uveitis: Retrospective analysis of efficacy, safety, and limiting factors.
Ann Rheum Dis, 64 (2005), pp. 962-964
[15.]
R. Lopez-Gonzalez, E. Loza, J.A. Jover, J.M. Benitez Del Castillo, R. Mendez, C. Hernandez-Garcia, et al.
Treatment of refractory posterior uveitis with infliximab: A 7-year follow-up study.
Scand J Rheumatol, 38 (2009), pp. 58-62
[16.]
E.B. Suhler, J.R. Smith, T.R. Giles, A.K. Lauer, M.S. Wertheim, D.E. Kurz, et al.
Infliximab Therapy for Refractory Uveitis: 2-Year Results of a Prospective Trial.
Arch Ophthalmol, 127 (2009), pp. 819-822
[17.]
L. Sobrin, E.C. Kim, W. Christen, T. Papadaki, E. Letko, C.S. Foster.
Infliximab therapy for the treatment of refractory ocular inflammatory disease.
Arch Ophthalmol, 125 (2007), pp. 895-900
[18.]
J. Braun, X. Baraliakos, J. Listing, J. Sieper.
Decreased Incidence of Anterior Uveitis in Patients With Ankylosing Spondylitis Treated With the Anti-Tumor Necrosis Factor Agents Infliximab and Etanercept.
Arthritis Rheum, 52 (2005), pp. 2447-2451
[19.]
S. Guignard, L. Gossec, C. Salliot, A. Ruyssen-Witrand, M. Luc, M. Duclos, et al.
Efficacy of tumour necrosis factor blockers in reducing uveitis flares in patients with spondylarthropathy: A retrospective study.
Ann Rheum Dis, 65 (2006), pp. 1631-1634
[20.]
L.L. Lim, F.W. Fraunfelder, J.T. Rosenbaum.
Do Tumor Necrosis Factor Inhibitors Cause Uveitis?. A Registry- Based Study.
Arthritis Rheum, 56 (2007), pp. 3248-3252
[21.]
I. Tugal-Tutkun, A. Mudun, M. Urgancioglu, S. Kamali, E. Kasapoglu, M. Inanc, et al.
Efficacy of Infliximab in the Treatment of Uveitis That Is Resistant to Treatment With the Combination of Azathioprine, Cyclosporine, and Corticosteroids in Behçet's Disease: An Open- Label Trial.
Arthritis Rheum, 52 (2005), pp. 2478-2484
[22.]
L. Niccoli, C. Nannini, M. Benucci, D. Chindamo, E. Cassarà, C. Salvarani, et al.
Long-term efficacy of infliximab in refractory posterior uveitis of Behçet's disease: A 24-month follow-up study.
Rheumatology, 46 (2007), pp. 1161-1164
[23.]
F. Alokaily, S. Alsaleh, M. Al-Balawi, S. Al-Rashidi.
Efficacy of infliximab on the acute attack of uveitis.
Saudi Med J, 31 (2010), pp. 82-85
[24.]
L. Niccoli, C. Nannini, E. Cassarà, G. Gini, I. Lenzetti, F. Cantini.
Efficacy of Infliximab in two patients with refractory Vogt-Koyanagi-Harada.
Br J Ophthalmol, 93 (2009), pp. 1553-1554
[25.]
Y. Wang, P.A. Gaudio.
Infliximab therapy for 2 patients with Vogt-Koyanagi-Harada Syndrome.
Ocul Immunol Inflamm, 16 (2008), pp. 167-171
[26.]
P. Kahn, M. Weiss, L.F. Imundo, D.M. Levy.
Favorable response to high-dose infliximab for refractory childhood uveitis.
Ophthalmology, 113 (2006), pp. 860-864
[27.]
G. Simonini, M.E. Zannin, R. Caputo, F. Falcini, M. de Martino, F. Zulian, et al.
Loss of efficacy during long-term infliximab therapy for sight-threatening childhood uveitis.
Rheumatology, 47 (2008), pp. 1510-1514
[28.]
S.P. Ardoin, D. Kredich, E. Rabinovich, L.E. Schanberg, G.J. Jaffe.
Infliximab to treat chronic noninfectious uveitis in children: retrospective case series with longterm follow-up.
Am J Ophthalmol, 144 (2007), pp. 844-849
[29.]
I. Foeldvari, S. Nielsen, J. Kümmerle-Deschner, G. Espada, G. Horneff, B. Bica, et al.
Tumor necrosis factoralpha blocker in treatment of juvenile idiopathic arthritis- associated uveitis refractory to second-line agents: results of a multinational survey.
J Rheumatol., 34 (2007), pp. 1146-1150
[30.]
B. Mushtaq, T. Saeed, R.D. Situnayake, P.I. Murray.
Adalimumab for sightthreatening uveitis in Behçet's disease.
Eye, 21 (2007), pp. 824-825
[31.]
S. Biester, C. Deuter, H. Michels, R. Haefner, J. Kuemmerle-Deschner, D. Doycheva, et al.
Adalimumab in the therapy of uveitis in childhood.
Br J Ophthalmol, 91 (2007), pp. 319-324
[32.]
L.B. Vazquez-Cobian, T. Flynn, T.J. Lehman.
Adalimumab therapy for childhood uveitis.
J Pediatr, 149 (2006), pp. 572-575
[33.]
P. Tynjälä, K. Kotaniemi, P. Lindahl, K. Latva, K. Aalto, V. Honkanen, et al.
Adalimumab in juvenile idiopathic arthritis-associated chronic anterior uveitis.
Rheumatology, 47 (2008), pp. 339-344
[34.]
M. Rudwaleit, E. Rødevand, P. Holck, J. Vanhoof, M. Kron, S. Kary, et al.
Adalimumab effectively reduces the rate of anterior uveitis flares in patients with active ankylosing spondylitis: Results of a prospective openlabel study.
Ann Rheum Dis, 68 (2009), pp. 696-701
[35.]
M. Diaz Llopis, L. Amselem, F.J. Romero, S. Garcia-Delpech, M.L. Hernandez.
Adalimumab therapy for Vogt-Koyanagi-Harada Syndrome.
Arch Soc Esp Oftalmol, 82 (2007), pp. 131-132
[36.]
S. Androudi, E. Tsironi, C. Kalogeropoulos, A. Theodoridou, P. Brazitikos.
Intravitreal adalimumab for refractory uveitis-related macular edema.
Ophthalmology, 117 (2010), pp. 1612-1616
[37.]
M. Diaz-Llopis, S. García-Delpech, D. Salom, P. Udaondo, M. Hernández-Garfella, F. Bosch-Morell, et al.
Adalimumab therapy for refractory uveitis: A pilot study.
J Ocul Pharmacol Ther, 24 (2008), pp. 351-361
[38.]
M.J. Lustig, E.T. Cunningham Jr..
Use of immunosuppressive agents in uveitis.
Curr Opin Ophthalmol, 14 (2003), pp. 399-412
[39.]
A. Reiff, S. Takei, S. Sadeghi, A. Stout, B. Shaham, B. Bernstein, et al.
Etanercept therapy in children with treatment- resistant uveitis.
Arthritis Rheum, 44 (2001), pp. 1411-1415
[40.]
H. Schmeling, G. Horneff.
Etanercept and uveitis in patients with juvenile idiopathic arthritis.
Rheumatology, 44 (2005), pp. 1008-1011
[41.]
J.R. Smith, R.D. Levinson, G.N. Holland, D.A. Jabs, M.R. Robinson, S.M. Whitcup, et al.
Differential efficacy of tumor necrosis factor inhibition in the management of inflammatory eye disease and associated rheumatic disease.
Arthritis Rheum, 45 (2001), pp. 252-257
[42.]
C.S. Foster, F. Tufail, N.K. Waheed, D. Chu, E. Miserocchi, S. Baltatzis, et al.
Efficacy of etanercept in preventing relapse of uveitis controlled by methotrexate.
Arch Ophthalmol, 121 (2003), pp. 437-440
[43.]
J.A. Smith, D.J. Thompson, S.M. Whitcup, E. Suhler, G. Clarke, S. Smith, et al.
A randomized, placebo-controlled, double-masked clinical trial of etanercept for the treatment of uveítis associated with juvenile idiopathic arthritis.
Arthritis Rheum, 53 (2005), pp. 18-23
[44.]
R.P. Baughman, E.E. Lower, D.A. Bradley, L.A. Raymond, A. Kaufman.
Etanercept for refractory ocular sarcoidosis: results of a double-blind randomized trial.
Chest, 128 (2005), pp. 1062-1067
[45.]
R.K. Saurenmann, A.V. Levin, B.M. Feldman, R.M. Laxer, R. Schneider, E.D. Silverman.
Risk of new-onset uveitis in patients with juvenile idiopathic arthritis treated with anti-TNF alpha agents.
J Pediatr, 149 (2006), pp. 833-836
[46.]
R.T. Sebastian, S.P. Harding, R.C. Bucknall, I.A. Pearce.
Optimizing the Use of Tumor Necrosis Factor Inhibitors in Refractory Uveitis.
Arch Ophthalmol, 124 (2006), pp. 1505
[47.]
V. Kakkassery, S. Mergler, U. Pleyer.
Anti-TNF-alpha treatment: a possible promoter in endogenous uveitis? Observational report on six patients: Occurrence of uveitis following etanercept treatment.
Curr Eye Res, 35 (2010), pp. 751-756
[48.]
J. Sieper, A. Koenig, S. Baumgartner, C. Wishneski, J. Foehl, B. Vlahos, et al.
Analysis of uveitis rates across all etanercept ankylosing spondylitis clinical trials.
Ann Rheum Dis., 69 (2010), pp. 226-229
[49.]
D. Fouache, V. Goëb, N. Massy-Guillemant, G. Avenel, H. Bacquet-Deschryver, M. Kozyreff-Meurice, et al.
Paradoxical adverse events of anti-tumour necrosis factor therapy for spondyloarthropathies: A retrospective study.
Rheumatology, 48 (2009), pp. 761-764
[50.]
S.M. Sharma, A.R. Nestel, R.W.J. Lee, A.D. Dick.
Clinical Review: Anti-TNF? Therapies in Uveitis: Perspective on 5 Years of Clinical Experience.
Ocul Immunol Inflamm, 17 (2009), pp. 403-414
Nombre y dirección de la institución o instituciones en las cuales se realizó el trabajo: Clínica Universitaria Bolivariana. Carrera 72 A núm. 78 B 50. Medellín, Colombia. El trabajo no fue soportado por alguna beca o por fondos de la industria farmacéutica.
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