scholarly journals Methotrexate Effectively Controls Ocular Inflammation in Japanese Patients With Non-infectious Uveitis

2021 ◽  
Vol 8 ◽  
Author(s):  
Yosuke Harada ◽  
Tomona Hiyama ◽  
Yoshiaki Kiuchi
Keyword(s):  
Adverse Effects ◽  
Anterior Uveitis ◽  
Immunosuppressive Treatment ◽  
Japanese Patients ◽  
Ocular Inflammation ◽  
Eye Drops ◽  
Systemic Corticosteroids ◽  
Rate Score ◽  
Wilcoxon Rank Sum Test ◽  
Infectious Uveitis

This single-center retrospective study investigated the clinical characteristics and efficacy of methotrexate (MTX) for the treatment of non-infectious uveitis for more than 6 months at Hiroshima University, from February 2016 to May 2021. Outcome variables included changes in systemic immunosuppressive treatment and intraocular inflammation. Out of 448 patients with non-infectious uveitis, 35 patients (14 male patients and 21 female patients; 65 eyes) treated with MTX for more than 6 months were analyzed. There were 15 patients with anterior uveitis and 20 with posterior and panuveitis. The mean dose of systemic corticosteroids decreased from 12.1 mg/day at baseline to 1.3 mg/day at 6 months and 0.6 mg at 12 months after starting MTX, and approximately 90% of patients were corticosteroid-free at 12 months. The percentage of eyes with inactive uveitis at 6, 12, and 24 months was 49.2%, 59.6%, and 90.0%, respectively. Mean relapse rate score also significantly decreased from 2.88 at baseline to 0.85 at 12 months (p < 0.001). Inflammatory control was achieved with MTX doses of 8–16 mg/week, with a median dose of 12 mg/week. Adverse effects of MTX were observed in 34.3% of patients, and 11.4% required discontinuation; most commonly hepatotoxicity (58.3%), followed by fatigue (25.0%), and hair loss (16.7%). No significant differences were found between the survival curves of patients with anterior uveitis and posterior/panuveitis (Wilcoxon rank-sum test). The percentage of eyes without IOP-lowering eye drops was significantly higher in patients with posterior/panuveitis at 24 months (p = 0.001). Our study suggests that MTX is effective in controlling ocular inflammation for Japanese patients with non-infectious uveitis. Relatively high incidence of MTX-related adverse effects in the Japanese population indicates that careful monitoring and dose adjustments are crucial for the long-term use of this therapy.

Undiagnosed Ocular Syphilis Treated With Immunosuppressive Therapy

2019 ◽  
Vol 3 (4) ◽  
pp. 242-245
Author(s):  
Palak R. Patel ◽  
Andrew C. Pittner ◽  
Pauline T. Merrill
Keyword(s):  
Visual Acuity ◽  
Immunosuppressive Therapy ◽  
Immunosuppressive Treatment ◽  
Case Series ◽  
Ocular Inflammation ◽  
Retrospective Case ◽  
Adequate Treatment ◽  
Screening Guidelines ◽  
Ocular Syphilis ◽  
Infectious Uveitis

Purpose: The purpose of this case series is to illustrate the importance of diagnosis and treatment of infectious uveitis and to suggest syphilis screening guidelines before the initiation of immunosuppressive therapy. Method: A retrospective case series (2016-2018) from a Chicago-area academic retina practice was conducted. Primary outcomes include ocular syphilis response to discontinuation of immunomodulatory agents and initiation of penicillin treatment as assessed by improvement of visual acuity and ocular inflammation. Results: Three patients with ocular syphilis in the setting of immunosuppressive therapy are presented. Two cases were identified of misdiagnosed ocular syphilis in patients initially treated with immunosuppressive therapy including adalimumab for their uveitis. A third case of ocular syphilis in a patient being treated with infliximab for ankylosing spondylitis is also presented. Once laboratory testing confirmed the presence of syphilis, immunosuppressive therapies were immediately stopped; signs of inflammation and visual acuity improved with adequate treatment for neurosyphilis including intravenous penicillin. Conclusions: Ocular syphilis may present in a variety of ways and cannot be ruled out without appropriate testing. Syphilitic uveitis should be on the differential of any patient presenting with ocular inflammation and screened for accordingly. It is particularly critical that syphilis be screened for before starting immunosuppressive treatment for uveitis to minimize the risk of long-term ocular damage from a treatable infectious uveitis. These cases convey the importance of establishing guidelines around screening for syphilis prior to starting immunosuppressive treatment for uveitis.

scholarly journals Comparison of adherence between fixed and unfixed topical combination glaucoma therapies using Japanese healthcare/pharmacy claims database: a retrospective non-interventional cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chikako Shirai ◽  
Nobushige Matsuoka ◽  
Toru Nakazawa
Keyword(s):  
Cohort Study ◽  
Real World ◽  
Fixed Combination ◽  
Japanese Patients ◽  
Eye Drops ◽  
Combination Therapies ◽  
Real World Data ◽  
Healthcare Database ◽  
Pharmacy Claims ◽  
Persistence Rate

Abstract Background Adherence to chronic therapies is crucial to prevent the progression of disease, such as glaucoma. However, only a limited number of studies have investigated them using real-world data in Japan. This study aimed to evaluate Japanese patients’ adherence to fixed- and unfixed-combination eye drops as a second-line therapy for glaucoma in real-world practice. Methods This retrospective, non-interventional cohort study utilized a commercially available Japanese healthcare database (MinaCare database). Medical/pharmacy claims data were collected from 2011 to 2016. The primary endpoint was adherence to medications, assessed by proportion of days covered (PDC) with medication during a 12-month post-index period. Meanwhile, the secondary endpoints included the persistence rate. Results A total of 738 patients were included in this study: 309 and 329 in the fixed- and unfixed-combination cohorts, respectively. Prostaglandin analog (PG)/β-blocker (BB) was most commonly claimed in 241/309 (78.0%) patients in the fixed-combination cohort. In the unfixed-combination cohort, PG and BB were claimed in 130/329 (39.5%) patients, whereas PG and α2-agonist were claimed in 87/329 (26.4%) patients. Patients were more adherent to the fixed-combination than the unfixed-combinations (mean PDCs [SD], 79.1% [32.1] vs. 62.2% [38.0]; P < 0.0001). The proportion of patients with good adherence (PDC ≥ 80%) was also higher in the fixed-combination cohort (69.6%) than in the unfixed-combination cohort (48.6%) (P < 0.0001). During the 12-month post-index period, the persistence rate was higher in the fixed-combination cohort than in the unfixed-combination cohort (47.6% [95% confidence intervals (CI): 41.9–53.0] vs. 24.9% [95% CI: 20.4–29.7], P < 0.0001). Conclusions Japanese patients with glaucoma preferred the fixed-combination therapies over the unfixed-combination therapies. Hence, fixed-combination therapies would contribute to the improvement of adherence.

A Survey of Neonatal Nurses on Mydriatic Regimens Used in Neonatal Retinopathy of Prematurity Eye Examinations

2021 ◽  
Author(s):  
Lisa Kremer ◽  
David Reith ◽  
Natalie J. Medlicott ◽  
Mary J. Sime ◽  
Liza Edmonds ◽  
...  
Keyword(s):  
New Zealand ◽  
Adverse Effects ◽  
Retinopathy Of Prematurity ◽  
Adverse Drug Events ◽  
Preterm Neonates ◽  
Eye Drops ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Aotearoa New Zealand ◽  
Adult Dose

Objective This study was aimed to determine mydriatic regimen(s) used in neonatal units in Aotearoa New Zealand (NZ) and Australia and to estimate the frequency of adverse drug events following mydriatic administration in preterm neonates. Study Design A cross-sectional survey was sent to neonatal nursing staff listed in the Australian and New Zealand Neonatal Network contact list. Participants were asked to state what mydriatic regimen they use, and to estimate the frequency of adverse drug events when eye drops were administered for retinopathy of prematurity eye examinations (ROPEE). Results Thirteen different mydriatic regimens were identified; phenylephrine 2.5% and cyclopentolate 0.5% (1 standard drop of each) was the most commonly used regimen. Two of the regimens exceeded adult doses and five regimens included a mydriatic that is equivalent to an adult dose. Following mydriatic instillation, the three most common adverse effects were apnea, tachycardia, and periorbital pallor. Conclusion Low-concentration single-microdrop regimens are currently in use and resulting in successful ROPEE, yet doses exceeding adult doses are in use throughout Aotearoa NZ and Australian units. We know from this dataset that neonates are experiencing unwanted and potentially preventable, adverse effects associated with mydriatics, and every effort should be made to minimize this risk. Key Points

Severe pulmonary complications in Japanese patients after bortezomib treatment for refractory multiple myeloma

Blood ◽  
2006 ◽  
Vol 107 (9) ◽  
pp. 3492-3494 ◽  
Author(s):  
Shigesaburo Miyakoshi ◽  
Masahiro Kami ◽  
Koichiro Yuji ◽  
Tomoko Matsumura ◽  
Masaaki Takatoku ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Adverse Effects ◽  
Gastrointestinal Symptoms ◽  
Japanese Patients ◽  
The United States ◽  
Underlying Disease ◽  
Pulmonary Complications ◽  
Bortezomib Treatment ◽  
Toranomon Hospital ◽  
Life Threatening

Bortezomib is a novel proteasome inhibitor with significant antimyeloma activity. Its frequent adverse effects are manageable, including gastrointestinal symptoms, peripheral neuropathy, and thrombocytopenia. Severe lung toxicity has not previously been reported. Between June 2004 and September 2005, 13 Japanese patients with multiple myeloma were treated with bortezomib in Toranomon Hospital, Juntendo University School of Medicine, and Jichi Medical School. Four of them developed severe pulmonary complications, and 2 died of respiratory failure without progression of underlying disease. To our knowledge, this is the first report on life-threatening pulmonary adverse effects after bortezomib therapy. Previous clinical studies on bortezomib, mostly in the United States and Europe, have shown low incidences of pulmonary adverse effects. Our study suggests that bortezomib can cause serious lung injury, and that its incidence might vary among different ethnicities. Clinicians need to be alert to the possibility.

scholarly journals Topical Treatment of Elevated Intraocular Pressure in Patients with Graves’ Ophthalmopathy

2020 ◽  
Author(s):  
Magdalena Gumińska ◽  
Roman Goś ◽  
Janusz Śmigielski ◽  
Michał Szymon Nowak
Keyword(s):  
Intraocular Pressure ◽  
Corticosteroid Therapy ◽  
Topical Treatment ◽  
Final Visit ◽  
Control Group ◽  
Eye Drops ◽  
Systemic Corticosteroids ◽  
Subgroup Ii ◽  
Elevated Intraocular Pressure ◽  
Study Participants

Purpose: The evaluation of the efficacy of topical hypotensive treatment and/or systemic corticosteroids therapy in patients with elevated intraocular pressure and Graves&rsquo; orbitopathy (GO). Methods: 172 eyes in 86 individuals with duration of GO &ge; 3 months, intraocular pressure in either eye &ge; 25.0 mmHg and GO ranked &ge; 3 at least in one eye in modified CAS form, were included. The study subjects were divided into three treatment subgroups: subgroup I was administered latanoprost QD; subgroup II was administered a combined preparation of brimonidine and timolol BID; subgroup III was the control group, not receiving any topical hypotensive treatment. All the study participants received systemic treatment &ndash; intravenous corticosteroid therapy at the same dose, according to the EUGOGO guideline Results: On the final visit, the mean IOP value was significantly lower in all treatment subgroups comparing to the initial values. In both subgroups receiving topical treatment the IOP reduction was higher than in the control group receiving systemic corticosteroids only. However, the latanoprost eye drops decreased intraocular pressure more effectively than drops containing brimonidine and timolol. Conclusion: Topical ocular hypotensive treatment is effective in reducing intraocular pressure in GO and decreases intraocular pressure more effectively than systemic corticosteroid therapy alone.

Conjunctivitis, episcleritis and anterior uveitis as the first presenting features of granulomatosis with polyangiitis

2021 ◽  
Vol 14 (10) ◽  
pp. e243558
Author(s):  
Lucas Donato Foster ◽  
Michael Nyugen ◽  
Edward Margolin
Keyword(s):  
Anterior Uveitis ◽  
Crescentic Glomerulonephritis ◽  
Granulomatosis With Polyangiitis ◽  
Oral Prednisone ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Final Diagnosis ◽  
Ocular Inflammation ◽  
Reactive Protein ◽  
Ocular Manifestations ◽  
Organ Systems

Granulomatosis with polyangiitis (GPA) is a rare disorder characterised by inflammation of small-sized and medium-sized blood vessels that result in damage to various organ systems, but it most commonly affects the respiratory tract and kidneys. It is one of the few entities that can present with ocular inflammation as well as renal impairment at the same time. We describe a case of a 38-year-old man with conjunctivitis, episcleritis, anterior uveitis as a first manifestation of GPA. His presentation with red eye and anterior uveitis prompted further workup, which revealed acute renal failure (creatinine 442 mmol/L), elevated inflammatory markers (erythrocyte sedimentation rate of 85 mmol/hour and C reactive protein of 72 mg/L), and a c-antineutrophil cytoplasmic antibody titre >8. An urgent renal biopsy was performed demonstrating necrotising crescentic glomerulonephritis, which led to the final diagnosis of GPA. Treatment induction with intravenous methylprednisolone and plasmapheresis followed by an oral prednisone taper and intravenous rituximab infusions leading to resolution of all symptoms and normalisation of kidney function. This report highlights conditions that can present with both ocular inflammation and renal dysfunction with a focus on GPA and its ocular manifestations.

Lens and Anterior Uvea

2022 ◽  
pp. 359-392
Keyword(s):  
Macular Edema ◽  
Anterior Uveitis ◽  
Clinical Signs ◽  
Inflammatory Cells ◽  
Clinical Findings ◽  
Eye Drops ◽  
Systemic Diseases ◽  
Intravitreal Triamcinolone ◽  
Keratic Precipitates ◽  
Intravitreal Triamcinolone Injection

This chapter illustrates photos of clinical signs seen in uveitis and interesting cases of lens pathologies. Anterior uveitis is the inflammation of the iris and the ciliary body. Anterior uveitis can be idiopathic, isolated, or associated with systemic diseases. The clinical findings observed in anterior uveitis include keratic precipitates, inflammatory cells and flare in anterior chamber, hypopyon, rarely hyphema, miosis, iris nodules and atrophy, synechiae, and band keratopathy in chronic cases (shown in corneal degenerations chapter). The inflammation in anterior uveitis is almost always immune. Treatment includes steroid eye drops, cycloplegic drops, sub-Tenon steroid injections when cystoid macular edema is present. Chronic macular edema can be treated with intravitreal Triamcinolone injection and Dexamethasone implants. In cases of refractory anterior uveitis or associated immune systemic diseases, immunomodulatory treatment or biologic agents are prescribed.

E

2020 ◽  
pp. 275-307
Author(s):  
Sean Ainsworth
Keyword(s):  
Adverse Effects ◽  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Recombinant Human Erythropoietin ◽  
Eye Drops ◽  
Enzyme Replacement ◽  
Maternal Treatment ◽  
Human Erythropoietin

This chapter presents information on neonatal drugs that begin with E, including use, pharmacology, adverse effects, fetal and infant implications of maternal treatment, treatment, and supply of Enemas, laxatives, and suppositories, Enoxaparin, Enzyme replacement therapy, Epoetin (recombinant human erythropoietin = rEPO), Epoprostenol and other prostanoids (iloprost and teoprostinil), Erythromycin, Esomeprazole, Ethambutol, and Eye drops (and ointments)

Corticosteroid Exposure in the Treatment of Severe COPD Exacerbations

2020 ◽  
pp. 089719002096122
Author(s):  
Jamie George ◽  
Michelle Ganoff ◽  
Melissa Lipari
Keyword(s):  
Adverse Effects ◽  
Prescribing Patterns ◽  
Medical Institution ◽  
Readmission Rates ◽  
Copd Exacerbations ◽  
Systemic Corticosteroids ◽  
Academic Medical ◽  
Appropriate Therapy ◽  
Exacerbation Of Copd ◽  
Support Treatment

Background: Recent literature and guidelines support treatment of severe acute exacerbation of COPD (AECOPD) with prednisone 40 mg (or equivalent) for 5 days. Objective: The purpose of this study was to determine whether systemic corticosteroids were being prescribed at the appropriate dose and duration in the treatment of severe AECOPD at a large academic medical institution. Methods: This was a single-center, retrospective, observational study conducted to evaluate corticosteroid prescribing patterns for adults admitted for severe AECOPD from March to May 2019 at a large academic medical institution. Appropriate therapy was defined as: prednisone 40 mg (or equivalent) for 5 days. The primary outcome was to determine the frequency of appropriate dose and duration. The secondary outcomes were to identify the frequency of appropriate dose or duration, compare the prevalence of adverse effects, such as new/worsening hyperglycemia or hypertension, and compare 30- and 90-day readmission rates. Results: Of the 190 patients included, 16 (8.4%) had an appropriate duration and 8 (4.2%) an appropriate dose. Only 4 patients (2.1%) had both appropriate corticosteroid dose and duration. New/worsening hyperglycemia occurred in 96 (50.5%), and hypertension developed in 13 (6.8%). Thirty-day readmission occurred in 46 (24.2%) and 90-day readmission in 78 (41.1%). These were more likely in those without appropriate dose and duration. Conclusion: Systemic corticosteroids for the treatment of severe AECOPD are not prescribed in accordance with evidence-based recommendations at this institution. This might result in a greater incidence of adverse effects and readmissions.

scholarly journals Recent Advances in the Design of Topical Ophthalmic Delivery Systems in the Treatment of Ocular Surface Inflammation and Their Biopharmaceutical Evaluation

Pharmaceutics ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 570 ◽  
Author(s):  
Roseline Mazet ◽  
Josias B. G. Yaméogo ◽  
Denis Wouessidjewe ◽  
Luc Choisnard ◽  
Annabelle Gèze
Keyword(s):  
Ocular Surface ◽  
Ex Vivo ◽  
Immunosuppressive Agents ◽  
Delivery Systems ◽  
Ocular Inflammation ◽  
Limiting Factors ◽  
Common Symptom ◽  
Eye Drops ◽  
Colloidal Systems

Ocular inflammation is one of the most common symptom of eye disorders and diseases. The therapeutic management of this inflammation must be rapid and effective in order to avoid deleterious effects for the eye and the vision. Steroidal (SAID) and non-steroidal (NSAID) anti-inflammatory drugs and immunosuppressive agents have been shown to be effective in treating inflammation of the ocular surface of the eye by topical administration. However, it is well established that the anatomical and physiological ocular barriers are limiting factors for drug penetration. In addition, such drugs are generally characterized by a very low aqueous solubility, resulting in low bioavailability as only 1% to 5% of the applied drug permeates the cornea. The present review gives an updated insight on the conventional formulations used in the treatment of ocular inflammation, i.e., ointments, eye drops, solutions, suspensions, gels, and emulsions, based on the commercial products available on the US, European, and French markets. Additionally, sophisticated formulations and innovative ocular drug delivery systems will be discussed. Promising results are presented with micro- and nanoparticulated systems, or combined strategies with polymers and colloidal systems, which offer a synergy in bioavailability and sustained release. Finally, different tools allowing the physical characterization of all these delivery systems, as well as in vitro, ex vivo, and in vivo evaluations, will be considered with regards to the safety, the tolerance, and the efficiency of the drug products.

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