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Safety of Immunosuppressive Therapy for Eye Diseases

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Immune Modulation and Anti-Inflammatory Therapy in Ocular Disorders

Abstract

Increasing evidence suggests that immunosuppressive therapy with antimetabolites and T-cell inhibitors, and likely also with biologics, is a safe and reasonably effective alternative or adjunct to long-term, high-dose corticosteroid therapy. Most patients tolerate antimetabolites and T-cell inhibitors without difficulty. If tolerance problems do occur, they are usually early in therapy and are reversible with dose adjustment or medication cessation. Alkylating agents appear to have a higher risk of opportunistic infection and cancer, which may limit their use to the most severe cases. TNF inhibitors appear to have a slightly increased risk of opportunistic infection and probably no increased risk of cancer; however, concerning preliminary data from the SITE cohort need to be evaluated further. The limited evidence available on interferons shows a high incidence of short-term flulike symptoms, while rituximab usually does not cause short-term toxicities. Neither interferons nor rituximab appears to have an increased risk of infection or other long-term adverse effects; however, further research is needed to evaluate their impact on risk of cancer and mortality. New immunosuppressive drugs also will need to be evaluated for safety and effectiveness as they become available.

Financial Support

This study was supported primarily by National Eye Institute Grant EY014943 (JHK). Additional support was provided by Research to Prevent Blindness and the Paul and Evanina Mackall Foundation.

Financial Disclosure(s)

The author(s) have made the following disclosure(s): John H. Kempen consultant of Lux Biosciences, Allergan, Alcon, Sanofi-Pasteur, Harbor BioSciences, and Xoma and recipient of grant from the National Eye Institute, Food and Drug Administration, and EyeGate Pharma.

Contributions

Design and conduct of the study (DMH, JHK); collection, management, analysis, and interpretation of the data (DMH, JHK); preparation, review, or approval of the manuscript (DMH, JHK)

Institutional Review Board Approval

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, The Scheie Eye Institute, The University of Pennsylvania, 51 N. 39th Street, Philadelphia, PA, 19104, USA

    Dana M. Hornbeak MD, MPH

  2. Department of Ophthalmology, Biostatistics and Epidemiology, The Scheie Eye Institute, The University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 700, Philadelphia, PA, 19104, USA

    John H. Kempen MD, MPH, MHS, PhD

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  1. Dana M. Hornbeak MD, MPH
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Correspondence to John H. Kempen MD, MPH, MHS, PhD .

Editor information

Editors and Affiliations

  1. Department of Ophthalmology, Charité Campus Virchow-Klinikum, Berlin, Germany

    Uwe Pleyer

  2. Division of Ophthalmology, Miguel Hernandez University, Vissum-Instituto Oftalmologico de Alicante, Alicante, Spain

    Jorge L. Alió

  3. Centre of Ocular Inflammation and Infection OCUVAC, Medical University of Vienna Laura Bassi Centre of Expertise, Vienna, Austria

    Talin Barisani-Asenbauer

  4. Department of Ophthalmology, Pitié-Salpêtrière’s University Hospital, Paris, France

    Phuc Le Hoang

  5. Doheny Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA

    Narsing A. Rao

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Hornbeak, D.M., Kempen, J.H. (2014). Safety of Immunosuppressive Therapy for Eye Diseases. In: Pleyer, U., Alió, J., Barisani-Asenbauer, T., Le Hoang, P., Rao, N. (eds) Immune Modulation and Anti-Inflammatory Therapy in Ocular Disorders. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54350-0_12

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