4 research outputs found
Immunomodulatory therapy in the management of multiple sclerosis-associated uveitis
Π¦Π΅Π»ΠΡΠ΅Π½ΠΊΠ° Π½Π° Π΅ΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡΠ° Π½Π° Π½Π΅ΠΊΠΎΡΡΠΈΠΊΠΎΡΡΠ΅ΡΠΎΠΈΠ΄Π½Π°ΡΠ° ΠΈΠΌΡΠ½ΠΎΠΌΠΎΠ΄ΡΠ»ΠΈΡΠ°ΡΠ° ΡΠ΅ΡΠ°ΠΏΠΈΡ Π·Π° ΠΏΠΎΡΡΠΈΠ³Π°Π½Π΅ Π½Π° ΡΠ΅ΠΌΠΈΡΠΈΡ ΠΈΠ»ΠΈ ΠΏΡΠΎΠ΄ΡΠ»ΠΆΠΈΡΠ΅Π»Π΅Π½ ΠΊΠΎΠ½ΡΡΠΎΠ» Π½Π° Π²ΡΠ·ΠΏΠ°Π»ΠΈΡΠ΅Π»Π½Π°ΡΠ° Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡ Π² ΡΠ»ΡΡΠ°ΠΈ Π½Π° ΡΠ²Π΅ΠΈΡΠΈ, Π°ΡΠΎΡΠΈΠΈΡΠ°Π½ΠΈ Ρ ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²Π΅Π½Π° ΡΠΊΠ»Π΅ΡΠΎΠ·Π°.ΠΠ΅ΡΠΎΠ΄ΠΈΠ Π΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎ ΠΏΡΠΎΡΡΠ²Π°Π½Π΅ Π²ΡΡΡ
Ρ 10 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ Ρ ΡΠ²Π΅ΠΈΡ ΠΈ ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²Π΅Π½Π° ΡΠΊΠ»Π΅ΡΠΎΠ·Π° Π½Π° "Massachusetts ΠΡΠ΅ Research and Surgery Institution". ΠΡΠ΅ΡΠ΅Π½ΠΊΠ°ΡΠ° Π·Π° Π΅ΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡΠ° Π½Π° ΡΠ΅ΡΠ°ΠΏΠΈΡΡΠ° ΡΠ΅ ΠΎΡΠ½ΠΎΠ²Π°Π²Π°ΡΠ΅ Π½Π° ΠΊΠΎΠ½ΡΡΠΎΠ»Π° Π½Π° Π²ΡΠ·ΠΏΠ°Π»ΠΈΡΠ΅Π»Π½Π°ΡΠ° Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡ Π½Π° ΡΠ²Π΅ΠΈΡΠ°.Π Π΅Π·ΡΠ»ΡΠ°ΡΠΈΠΡΠΈΡΠΊΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ Π±ΡΡ
Π° ΠΎΡ ΠΆΠ΅Π½ΡΠΊΠΈ ΠΏΠΎΠ» ΠΈ Π±ΡΠ»Π° Π΅Π²ΡΠΎΠΏΠ΅ΠΈΠ΄Π½Π° ΡΠ°ΡΠ° ΠΈ ΡΡΠ΅Π΄Π½Π° Π²ΡΠ·ΡΠ°ΡΡ 49.Π Π³ΠΎΠ΄ΠΈΠ½ΠΈ. ΠΠ½ΡΠ΅ΡΠΌΠ΅Π΄ΠΈΠ΅ΡΠ΅Π½ ΡΠ²Π΅ΠΈΡ ΠΈΠΌΠ°Ρ
Π° 6 Π±ΠΎΠ»Π½ΠΈ (60%), ΠΏΠ°Π½ΡΠ²Π΅ΠΈΡ- Π (Π0%), Π·Π°Π΄Π΅Π½ ΡΠ²Π΅ΠΈΡ- 1 (10%). ΠΡΠΈΡΠΊΠΈ ΡΠ»ΡΡΠ°ΠΈ Π±ΡΡ
Π° Π΄Π²ΡΡΡΡΠ°Π½Π½ΠΈ. ΠΠΌΡΠ½ΠΎΡΡΠΏΡΠ΅ΡΠΈΠ²Π½Π°ΡΠ° ΠΌΠΎΠ½ΠΎΡΠ΅ΡΠ°ΠΏΠΈΡ Π±Π΅ΡΠ΅ Ρ ΠΌΠ΅ΡΠΎΡΡΠ΅ΠΊΡΠ°Ρ ΠΏΡΠΈ 5 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ (50%), ΠΌΠΈΠΊΠΎΡΠ΅Π½ΠΎΠ»Π°Ρ ΠΌΠΎΡΠ΅ΡΠΈΠ»- ΠΏΡΠΈ 4 (40%), Π΄Π°ΠΊΠ»ΠΈΠ·ΡΠΌΠ°Π± - ΠΏΡΠΈ 2 (20%), ΡΠΈΠΊΠ»ΠΎΡΠ°ΡΡΠ°ΠΌΠΈΠ΄-ΠΏΡΠΈ 2 (20%), ΠΌΠ΅ΡΠΎΡΡΠ΅ΠΊΡΠ°Ρ- ΠΏΡΠΈ 1 (10%), ΠΈ ΡΠΈΠΊΠ»ΠΎΡΠΏΠΎΡΠ½ΠΈ-ΠΏΡΠΈ 1 (10%) ΠΏΠ°ΡΠΈΠ΅Π½Ρ. ΠΠΎΠΌΠ±ΠΈΠ½ΠΈΡΠ°Π½Π°ΡΠ° ΠΈΠΌΡΠ½ΠΎΠΌΠΎΠ΄ΡΠ»Π°ΡΠΈΡ Π±Π΅ΡΠ΅ Ρ ΠΌΠΈΠΊΠ°ΡΠ΅Π½ΠΎΠ»Π°Ρ ΠΌΠΎΡΠ΅ΡΠΈΠ» ΠΈ ΡΠΈΠΊΠ»ΠΎΡΠΏΠΎΡΠ½ΠΈ Π² 4 ΡΠ»ΡΡΠ°ΠΈ (40%), Π°Π·Π°ΡΠΈΠΎΠΏΡΠΈΠ½ Ρ ΡΠΈΠΊΠ»ΠΎΡΠΏΠΎΡΠΈΠ½ - Π² 2 (20%), ΠΈ ΠΌΠ΅ΡΠΎΡΡΠ΅ΠΊΡΠ°Ρ ΠΈ ΡΠΈΠΊΠ»ΠΎΡΠΏΠΎΡΠΈΠ½ - Π² 1 (10%). ΠΡΠΈΡΠΊΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΠΈΠ·ΠΏΠΎΠ»Π·Π²Π°Ρ
Π° ΠΊΠΎΡΡΠΈΠΊΠΎΡΡΠ΅ΡΠΎΠΈΠ΄ΠΈ Π² ΠΏΠ΅ΡΠΈΠΎΠ΄Π° Π½Π° ΠΏΡΠΎΡΠ»Π΅Π΄ΡΠ²Π°Π½Π΅ΡΠΎ. Π‘Π΅Π΄Π΅ΠΌ Π±ΠΎΠ»Π½ΠΈ (70%) ΠΏΡΠΎΠ²Π΅ΠΆΠ΄Π°Ρ
Π° ΡΠ΅ΡΠ°ΠΏΠΈΡ Π·Π° ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²Π΅Π½Π° ΡΠΊΠ»Π΅ΡΠΎΠ·Π°, ΠΎΡ ΠΊΠΎΠΈΡΠΎ ΠΏΡΠΈ Π (Π0%)- Ρ Π³Π»Π°ΡΠΈΡΠ°ΠΌΠ΅Ρ Π°ΡΠ΅ΡΠ°Ρ, ΠΈΠ½ΡΠ΅ΡΡΠ΅ΡΠΎΠ½ Π±Π΅ΡΠ°- 1 -Π°- ΡΡΡΠΎ ΠΏΡΠΈ Π (Π0%), ΠΈ ΠΈΠ½ΡΠ΅ΡΡΠ΅ΡΠΎΠ½ Π±Π΅ΡΠ° -1 -Π± - ΠΏΡΠΈ 1 (10%). Π ΠΊΡΠ°Ρ Π½Π° ΠΏΠ΅ΡΠΈΠΎΠ΄Π° Π½Π° ΠΏΡΠΎΡΠ»Π΅Π΄ΡΠ²Π°Π½Π΅ ΠΏΡΠΈ 1 ΠΏΠ°ΡΠΈΠ΅Π½Ρ ΡΠ²Π΅ΠΈΡΡΡ Π±Π΅ΡΠ΅ Π² ΡΠ΅ΠΌΠΈΡΠΈΡ ΡΠ»Π΅Π΄ ΡΠ΅ΡΠ°ΠΏΠΈΡ Ρ Π°Π·Π°ΡΠΈΠΎΠΏΡΠΈΠ½, a ΠΏΡΠΈ 5 Π±ΠΎΠ»Π½ΠΈ (50%) ΠΏΡΠΎΡΠ΅ΡΡΡ ΡΠ΅ ΠΊΠΎΠ½ΡΡΠΎΠ»ΠΈΡΠ°ΡΠ΅ ΠΎΡ ΠΏΡΠΎΠ΄ΡΠ»ΠΆΠΈΡΠ΅Π»Π½Π° ΡΠ΅ΡΠ°ΠΏΠΈΡ Ρ ΠΈΠΌΡΠ½ΠΎΡΡΠΏΡΠ΅ΡΠΎΡΠΈ ΠΈ/ΠΈΠ»ΠΈ ΠΊΠΎΡΡΠΈΠΊΠΎΡΡΠ΅ΡΠΎΠΈΠ΄ΠΈ. ΠΡΠΈΠ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ (Π0%) ΡΠ΅ Π½Π°Π»ΠΎΠΆΠΈ ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΈΡ Π½Π° Π²ΡΡΡΠ΅ΠΎΡΠ΅Π½ ΠΊΠΎΡΡΠΈΠΊΠΎΡΡΠ΅ΡΠΎΠΈΠ΄Π΅Π½ ΠΈΠΌΠΏΠ»Π°Π½Ρ.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅ΠΠΎΠ½Π²Π΅Π½ΡΠΈΠΎΠ½Π°Π»Π½ΠΈΡΠ΅ ΠΈΠΌΡΠ½ΠΎΡΡΠΏΡΠ΅ΡΠΎΡΠΈ ΠΌΠΎΠ³Π°Ρ Π΄Π° ΠΎΡΠΈΠ³ΡΡΡΡ ΠΏΡΠΎΠ΄ΡΠ»ΠΆΠΈΡΠ΅Π»Π΅Π½ ΠΏΡΠΎΡΠΈΠ²ΠΎΠ²ΡΠ·ΠΏΠ°Π»ΠΈΡΠ΅Π»Π΅Π½ ΠΊΠΎΠ½ΡΡΠΎΠ» ΠΏΡΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ Ρ ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²Π΅Π½Π° ΡΠΊΠ»Π΅ΡΠΎΠ·Π° - Π°ΡΠΎΡΠΈΠΈΡΠ°Π½ ΡΠ²Π΅ΠΈΡ. Π Π½Π°ΡΡΠΎΡΡΠΎΡΠΎ ΠΏΡΠΎΡΡΠ²Π°Π½Π΅ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΠΈΡΠ΅ Π·Π° ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²Π΅Π½Π° ΡΠΊΠ»Π΅ΡΠΎΠ·Π° ΠΈΠΌΡΠ½ΠΎΠΌΠΎΠ΄ΡΠ»ΠΈΡΠ°ΡΠΈ ΠΌΠ΅Π΄ΠΈΠΊΠ°ΠΌΠ΅Π½ΡΠΈ - ΠΈΠ½ΡΠ΅ΡΡΠ΅ΡΠΎΠ½ Π±Π΅ΡΠ° 1 - Π°Π»ΡΠ° ΠΈ Π±Π΅ΡΠ° ΠΈ Π³Π»Π°ΡΠΈΡΠ°ΠΌΠ΅Ρ Π°ΡΠ΅ΡΠ°Ρ, Π±ΡΡ
Π° Π΅ΡΠ΅ΠΊΡΠΈΠ²Π½ΠΈ Π·Π° Π΅ΠΊΡΡΡΠ°ΠΎΠΊΡΠ»Π°ΡΠ½ΠΈΡΠ΅ ΠΏΡΠΎΡΠ²ΠΈ Π½Π° Π·Π°Π±ΠΎΠ»ΡΠ²Π°Π½Π΅ΡΠΎ, Π½ΠΎ Π½Π΅ ΡΡΠΏΡΡ
ΠΌΠ΅ Π΄Π° Π΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠ°ΠΌΠ΅ ΠΊΠ°ΡΠ΅Π³ΠΎΡΠΈΡΠ½ΠΎ Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΠΎ ΠΏΠΎΠ²Π»ΠΈΡΠ²Π°Π½Π΅ Π½Π° Π²ΡΡΡΠ΅ΠΎΡΠ½ΠΎΡΠΎ Π²ΡΠ·ΠΏΠ°Π»Π΅Π½ΠΈΠ΅.PurposeTo assess the efficacy of immunomodulatory therapy in achieving remission and long-term control of inflammation in patients with multiple sclerosis-associated uveitis.MethodsWe did a retrospective case series study on the clinical records of 10 patients with uveitis and multiple sclerosis, treated at the Massachusetts Eye Research and Surgery Institution. The period of study was from July 2005 until November 2012. The evaluation of effectiveness was based on the control of intraocular inflammation.ResultsAll patients were female, white, with mean age 49.3 years. Intermediate uveitis was diagnosed in 6 cases (60%), panuveitis - in 3 (30%), posterior - in 1 (10%). Bilateral involvement was present in all (100%) patients.Immunomodulatory medications as monotherapy included methotrexate - in 5 (50%), mycophenolate mofetil - in 4 (40%), daclizumab - in 2 (20%), cyclophosphamide - in 2 (20%), methotrexate - in 1 (10%), and cyclosporin - in 1 (10%) patient. Combined therapy was used with mycophenolate mofetil and cyclosporine in 4 cases (40%), cyclosporin and azathioprine - in 2 (20%), and methotrexate and cyclosporin - in 1 (10%).Corticosteroids were used by all patients. Seven patients (70%) had systemic therapy for multiple sclerosis with Glatiramer acetate in 3 (30%) of them, interferon beta-1a - in 3 (30%), and interferon beta-1b - in 1 (10%). At the end of follow-up, 1 patient (10%) was in remission for 19 months following azathioprine therapy, 2 (20%) - quiescent with no immunomodulatory therapy or corticosteroids for 6 and 12 months, with no previous stable remission, 1 (10%) - stable on mycophenolate mofetil and cyclosporin for 21 months, 2 (20%) - maintained on immunomodulatory therapy and corticosteroids for 8 and 37 months, 5 eyes of 3 patients - quiescent after fluocinolone acetonide intravitreal implant for as long as 60 months, 3 eyes of 2 patients had signs of active disease.ConclusionsNon-corticosteroid conventional systemic immunomodulatory medications can maintain long-term control of intraocular inflammation in multiple sclerosis - associated uveitis. The specific multiple sclerosis disease modifying drugs in our study, which were IFN beta-1b, IFN beta-1a, and glatiramer acetate, were efficacious for the management of the non-ocular manifestations of MS but we could not demonstrate a definitive benefit in the control of ocular inflammation, prevention of complications, and steroid-sparing