Benefit of intravenous immu>oglobulin in patients with refractory uveitis: preliminary results

James (Jim) Rosenbaum, R. George, C. Gordon

Research output: Contribution to journalArticle

Abstract

Purpose. Severe uveitis may fail to respond to immunosuppressive medications such as corticosteroids, cyclosporine, antimetabolits, or alkylating drugs. Intravenous immunoglobulin (IVIg) is effective in a variety of autoimmune diseases including juvenile dermatomyositis, idiopathic thrombocytopetiic purpura, and Guillain-Barre syndrome. Methods. We conducted an open label study on the benefits of IVIg(Baxter Pharmaceuticals) (0.5 gm/kg daily times 3 ind repeated monthly) for 6 patients whose bilateral uveitis had not responded to oral immunosuppressive medications. Five patients were female. The average age was 41 yrs.; the average duration of uveitis prior to IVIg was 5.9 yrs.; the median visual acuity prio' to treatment was 20/80 to 20/100. One patient had sarcoidosis; one had Behcet's; one had birdshot choroidopathy; one had pars planitis; and two had idiopathic disease. Results. From baseline examination to final follow-up four of six patients experienced :l or more lines of improvement in visual acuity (ETDRS scale) in at least one eye and a fif Ji patient experienced 2 lines of improvement in each eye. The average length of follow-up has been 5.4 months (range 1.5 to 9 months). The patient with sarcoidosis was able to discontinue prednisone and methotrexate while reducing cyclosporine dosage; die patient with Behcet's discontinued azathioprine and cyclosporine while experiencing improved ;ontrol of his systemic disease. No significant toxicity was reported. Conclusion;. These preliminary observations are based on a small number of patients with limited follow-up. However, the results are superior to what we have previously achieved with other immunosuppressive medications including intravenous ;yclophosphamide. IVIg should be considered for patients with refractory uveitis, but cost and proof of long term efficacy should lim t its current use.

Original languageEnglish (US)
JournalInvestigative Ophthalmology and Visual Science
Volume38
Issue number4
StatePublished - 1997

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Uveitis
Intravenous Immunoglobulins
Immunosuppressive Agents
Cyclosporine
Sarcoidosis
Visual Acuity
Pars Planitis
Guillain-Barre Syndrome
Purpura
Azathioprine
Prednisone
Methotrexate
Pharmaceutical Preparations
Autoimmune Diseases
Adrenal Cortex Hormones
Costs and Cost Analysis

ASJC Scopus subject areas

  • Ophthalmology

Cite this

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title = "Benefit of intravenous immu>oglobulin in patients with refractory uveitis: preliminary results",
abstract = "Purpose. Severe uveitis may fail to respond to immunosuppressive medications such as corticosteroids, cyclosporine, antimetabolits, or alkylating drugs. Intravenous immunoglobulin (IVIg) is effective in a variety of autoimmune diseases including juvenile dermatomyositis, idiopathic thrombocytopetiic purpura, and Guillain-Barre syndrome. Methods. We conducted an open label study on the benefits of IVIg(Baxter Pharmaceuticals) (0.5 gm/kg daily times 3 ind repeated monthly) for 6 patients whose bilateral uveitis had not responded to oral immunosuppressive medications. Five patients were female. The average age was 41 yrs.; the average duration of uveitis prior to IVIg was 5.9 yrs.; the median visual acuity prio' to treatment was 20/80 to 20/100. One patient had sarcoidosis; one had Behcet's; one had birdshot choroidopathy; one had pars planitis; and two had idiopathic disease. Results. From baseline examination to final follow-up four of six patients experienced :l or more lines of improvement in visual acuity (ETDRS scale) in at least one eye and a fif Ji patient experienced 2 lines of improvement in each eye. The average length of follow-up has been 5.4 months (range 1.5 to 9 months). The patient with sarcoidosis was able to discontinue prednisone and methotrexate while reducing cyclosporine dosage; die patient with Behcet's discontinued azathioprine and cyclosporine while experiencing improved ;ontrol of his systemic disease. No significant toxicity was reported. Conclusion;. These preliminary observations are based on a small number of patients with limited follow-up. However, the results are superior to what we have previously achieved with other immunosuppressive medications including intravenous ;yclophosphamide. IVIg should be considered for patients with refractory uveitis, but cost and proof of long term efficacy should lim t its current use.",
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T1 - Benefit of intravenous immu>oglobulin in patients with refractory uveitis

T2 - preliminary results

AU - Rosenbaum, James (Jim)

AU - George, R.

AU - Gordon, C.

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N2 - Purpose. Severe uveitis may fail to respond to immunosuppressive medications such as corticosteroids, cyclosporine, antimetabolits, or alkylating drugs. Intravenous immunoglobulin (IVIg) is effective in a variety of autoimmune diseases including juvenile dermatomyositis, idiopathic thrombocytopetiic purpura, and Guillain-Barre syndrome. Methods. We conducted an open label study on the benefits of IVIg(Baxter Pharmaceuticals) (0.5 gm/kg daily times 3 ind repeated monthly) for 6 patients whose bilateral uveitis had not responded to oral immunosuppressive medications. Five patients were female. The average age was 41 yrs.; the average duration of uveitis prior to IVIg was 5.9 yrs.; the median visual acuity prio' to treatment was 20/80 to 20/100. One patient had sarcoidosis; one had Behcet's; one had birdshot choroidopathy; one had pars planitis; and two had idiopathic disease. Results. From baseline examination to final follow-up four of six patients experienced :l or more lines of improvement in visual acuity (ETDRS scale) in at least one eye and a fif Ji patient experienced 2 lines of improvement in each eye. The average length of follow-up has been 5.4 months (range 1.5 to 9 months). The patient with sarcoidosis was able to discontinue prednisone and methotrexate while reducing cyclosporine dosage; die patient with Behcet's discontinued azathioprine and cyclosporine while experiencing improved ;ontrol of his systemic disease. No significant toxicity was reported. Conclusion;. These preliminary observations are based on a small number of patients with limited follow-up. However, the results are superior to what we have previously achieved with other immunosuppressive medications including intravenous ;yclophosphamide. IVIg should be considered for patients with refractory uveitis, but cost and proof of long term efficacy should lim t its current use.

AB - Purpose. Severe uveitis may fail to respond to immunosuppressive medications such as corticosteroids, cyclosporine, antimetabolits, or alkylating drugs. Intravenous immunoglobulin (IVIg) is effective in a variety of autoimmune diseases including juvenile dermatomyositis, idiopathic thrombocytopetiic purpura, and Guillain-Barre syndrome. Methods. We conducted an open label study on the benefits of IVIg(Baxter Pharmaceuticals) (0.5 gm/kg daily times 3 ind repeated monthly) for 6 patients whose bilateral uveitis had not responded to oral immunosuppressive medications. Five patients were female. The average age was 41 yrs.; the average duration of uveitis prior to IVIg was 5.9 yrs.; the median visual acuity prio' to treatment was 20/80 to 20/100. One patient had sarcoidosis; one had Behcet's; one had birdshot choroidopathy; one had pars planitis; and two had idiopathic disease. Results. From baseline examination to final follow-up four of six patients experienced :l or more lines of improvement in visual acuity (ETDRS scale) in at least one eye and a fif Ji patient experienced 2 lines of improvement in each eye. The average length of follow-up has been 5.4 months (range 1.5 to 9 months). The patient with sarcoidosis was able to discontinue prednisone and methotrexate while reducing cyclosporine dosage; die patient with Behcet's discontinued azathioprine and cyclosporine while experiencing improved ;ontrol of his systemic disease. No significant toxicity was reported. Conclusion;. These preliminary observations are based on a small number of patients with limited follow-up. However, the results are superior to what we have previously achieved with other immunosuppressive medications including intravenous ;yclophosphamide. IVIg should be considered for patients with refractory uveitis, but cost and proof of long term efficacy should lim t its current use.

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