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Vol. 18. Núm. 1.
Páginas 42-54 (Marzo 2011)
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Vol. 18. Núm. 1.
Páginas 42-54 (Marzo 2011)
DOI: 10.1016/S0121-8123(11)70062-7
Acceso a texto completo
Uveítis y terapia anti-TNF
Uveitis and anti-TNF therapy
Visitas
...
Carlos Jaime Velásquez Franco1,2,
Autor para correspondencia
carjaivel@hotmail.com

Correspondencia.
, Patricia Monsalve3, Gloria Isabel Salazar Martínez3, Ana Rivera3, Liliana Zuluaga2,4, Claudia Durán5, Francisco Vargas1,2, Aura Ligia Zapata-Castellanos2,6, Oscar Jaír-Felipe Díaz1,2
1 Reumatólogo. Unidad de Reumatología y Enfermedades Autoinmunes, Clínica Universitaria Bolivariana. Medellín, Colombia
2 Docente Facultad de Medicina. Escuela de Ciencias de la Salud. Universidad Pontificia Bolivariana. Medellín, Colombia
3 Residente de Oftalmología. Universidad Pontificia Bolivariana. Medellín, Colombia
4 Oftalmóloga Retinóloga, Facultad de Medicina, Universidad Pontificia Bolivariana. Clínica Universitaria Bolivariana. Medellín, Colombia
5 Oftalmóloga Especialista en Uveítis. Clínica Oftalmológica de San Diego. Medellín, Colombia
6 Reumatóloga pediatra. Unidad de Reumatología y Enfermedades Autoinmunes, Clínica Universitaria Bolivariana. Medellín, Colombia
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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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.

Los autores declaran no presentar ningún conflicto de interés al momento de la redacción del manuscrito.

Copyright © 2011. Asociación Colombiana de Reumatología
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