Anti TNF tedavisi seyrinde gelişen üveitler: primer hastalıktan mı ilaçtan mı?

Anti-TNF ilaçlar, non-enfeksiyoz üveit için günümüzde etkinliği kanıtlanmış yaygın kullanılan tedavilerdir. Mevcut tüm anti-TNF ilaçların üveit tedavisinde olumlu etkileri bildirilmiştir. Ancak retrospektif ve gözlemsel çalışmalarda etanersept tedavisi sonrası düşük etkinlik veya paradoksal etkiye bağlı olarak üveit gelişimi bildirilmiştir. Paradoksal reaksiyonlar, Anti-TNF tedavisi sırasında, bu ilaca bağlı olarak gelişen ve genellikle bu grup ilaçlara yanıt veren patolojik durumlar olarak tanımlanır. Paradoksik üveit tedavisini, hastaların altta yatan hastalığının ve üveitin durumları ve hastanın demografik verileri belirlemelidir.

Uveitis under anti-TNF therapy: Adverse effect or disease course?

Anti-TNFs are proven to be effective and widely used drugs for no-infectious uveitis. All anti-TNFs are reported to have positive results for uveitis. However, in retrospective or observatory studies, uveitis is reported after etanercept, as a result of low effectivity or paradoxical reaction. Paradoxical reactions are defined as the conditions, responsive to the drug, which occur during treatment with the drug and are attributed to the drug. The treatment of paradoxical uveitis should be determined by the underlying condition, severity of uveitis and demographic features of the patient.

PDF

___

1. Fabiani C, Vitale A, Lopalco G, Iannone F, Frediani B, Cantarini L. Different roles of TNF inhibitors in acute anterior uveitis associated with ankylosing spondylitis: state of the art. Clin Rheumatol 2016; 35(11):2631-2638.

2. Toussirot É, Aubin F. Paradoxical reactions under TNF-α blocking agents and other biological agents given for chronic immunemediated diseases: an analytical and comprehensive overview. RMD Open 2016;2(2):e000239. doi: 10.1136/rmdopen-2015- 000239.

3. Cobo-Ibáñez T, del Carmen Ordóñez M, Muñoz-Fernández S, Madero-Prado R, Martín-Mola E. Do TNF-blockers reduce or induce uveitis? Rheumatology (Oxford) 2008;47(5):731-2.

4. Lim LL, Fraunfelder FW, Rosenbaum JT. Do tumor necrosis factor inhibitors cause uveitis? A registry-based study. Arthritis Rheum 2007;56(10):3248-52.

5. Wendling D, Paccou J, Berthelot JM, et al. New onset of uveitis during anti-tumor necrosis factor treatment for rheumatic diseases. Semin Arthritis Rheum 2011;41(3):503-10.

6. Lie E, Lindström U, Zverkova-Sandström T, et al. Tumour necrosis factor inhibitör treatment and occurrence of anterior uveitis in ankylosing spondylitis: results from the Swedish biologics register. Ann Rheum Dis 2017;76(9):1515-21.

7. Foeldvari I, Becker I, Horneff G. Uveitis Events During Adalimumab, Etanercept, and Methotrexate Therapy in Juvenile Idiopathic Arthritis: Data From the Biologics in Pediatric Rheumatology Registry. Arthritis Care Res (Hoboken) 2015;67(11):1529-35.

8. Raffeiner B, Ometto F, Bernardi L, Botsios C, Punzi L. Inefficacy or paradoxical effect? Uveitis in ankylosing spondylitis treated with etanercept. Case Rep Med 2014;2014:471319.doi: 10.1155/2014/471319.