Implant Compared to Systemic Anti-inflammatory Therapy for Treating Uveitis

Systemic corticosteroid + immunosuppressive therapy linked to better visual acuity
Systemic corticosteroid + immunosuppressive therapy linked to better visual acuity

(HealthDay News) — Systemic therapy is associated with improved visual acuity compared with intravitreous fluocinolone acetonide implants for patients with uveitis, according to a study published online May 6 in the Journal of the American Medical Association.

John H. Kempen, M.D., Ph.D., from Massachusetts Eye and Ear in Boston, and colleagues compared intravenous fluocinolone acetonide implant and systemic therapy in patients with uveitis in a non-prespecified seven-year observational follow-up of the Multicenter Uveitis Steroid Treatment randomized trial. Two hundred fifteen patients with intermediate, posterior, or panuveitis consented to ongoing follow-up.

Data were included for 161 uveitic eyes assigned to implant and 167 uveitic eyes assigned to systemic therapy. The researchers found that from baseline through seven years the change in mean visual acuity favored systemic therapy by 7.2 letters. The cumulative seven-year incidence of protocol-specified, prospectively collected systemic adverse outcomes was less than 10 percent in the implant and systemic therapy groups, apart from hyperlipidemia (6.1 versus 11.2 percent), hypertension (9.8 versus 18.4 percent), osteopenia (41.5 versus 43.1 percent), fractures (11.3 versus 18.6 percent), hospitalization (47.6 versus 42.3 percent), and antibiotic-treated infections (57.4 versus 72.3 percent).

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"In seven-year extended follow-up of a randomized trial of patients with severe intermediate, posterior, or panuveitis, those randomized to receive systemic therapy had better visual acuity than those randomized to receive intravitreous fluocinolone acetonide implants," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry. Bausch & Lomb provided support in the form of donation of fluocinolone acetonide implants for patients randomized to implant therapy who were uninsured or unable to pay for implants.

Abstract/Full Text