Outcomes of treatment with sirolimus for non-infectious uveitis: a meta-analysis and systematic review

Vicente Lorenzo O Cabahug,1 Harvey S Uy,1,2 Ellen Yu-Keh,1 Kristine Joy D Sapno3 1St Luke’s Medical Center, Quezon City, Philippines; 2University of the Philippines, Manila, Philippines; 3University of Santo Tomas Hospital, Manila, Philippines Background: Uveitis is a group of intraocula...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Cabahug VLO, Uy HS, Yu-Keh E, Sapno KJD
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	Non-infectious uveitis Immunosuppression Corticosteroid-sparing Sirolimus mTOR inhibitors uveitis treatment Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/f6bdb4b0eaa2440883c96a7c989706f1
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:f6bdb4b0eaa2440883c96a7c989706f1
record_format	dspace
spelling	oai:doaj.org-article:f6bdb4b0eaa2440883c96a7c989706f12021-12-02T05:38:15ZOutcomes of treatment with sirolimus for non-infectious uveitis: a meta-analysis and systematic review1177-5483https://doaj.org/article/f6bdb4b0eaa2440883c96a7c989706f12019-04-01T00:00:00Zhttps://www.dovepress.com/outcomes-of-treatment-with-sirolimus-for-non-infectious-uveitis-a-meta-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Vicente Lorenzo O Cabahug,1 Harvey S Uy,1,2 Ellen Yu-Keh,1 Kristine Joy D Sapno3 1St Luke’s Medical Center, Quezon City, Philippines; 2University of the Philippines, Manila, Philippines; 3University of Santo Tomas Hospital, Manila, Philippines Background: Uveitis is a group of intraocular inflammatory diseases whose primary treatment involves immunosuppression. Although corticosteroids (CSs) remain the mainstay therapy, sirolimus is among the recently studied immunomodulatory drugs for treating noninfectious uveitis (NIU).Objective: The aim of this review was to assess and summarize the updated evidence on the outcomes of treatment with sirolimus for NIU.Materials and methods: Two reviewers conducted a systematic search on November 5, 2018, of electronic databases (EMBASE, MEDLINE, and The Cochrane Library) and clinical trial registers having no restrictions on language or publication date. The primary outcome was uveitis activity as measured by vitreous haze (VH), while the secondary outcomes included central macular thickness (CMT), best-corrected visual acuity (BCVA), CS-sparing effect, IOP elevation, and other adverse events. A meta-analysis was conducted on selected studies with appropriate clinical and methodological homogeneity.Results: Seven studies were included and reviewed. Four randomized clinical trials were eligible for meta-analysis: SAVE 2013, One-year outcomes of the SAVE study, SAVE 2 2016, SAKURA 2016. The pooled proportions of inflammation control (VH improvement) were 38% (95% CI 16.19%–62.66%) during a 6-month follow-up and 49.97% (95% CI 16.19%–83.03%) during a 6- to 12-month follow-up with the latter showing a significantly higher response rate (p=0.0472). BCVA improvement was 62.2% (95% CI 33.17%–87.11%) during a 6-month follow-up and 56.86% (95% CI 20.91%–89.05%) during a 6- to 12-month follow-up with no significant difference between the two (p=0.3705). Increased IOP remained at 7.11% (95% CI 3.46%–12.68%) for both a 6-month follow-up and up to a 12-month follow-up duration. The CS-sparing effect of sirolimus was also well demonstrated. A reduction in CMT was observed, and only minor drug-related adverse events were reported in all the studies reviewed.Conclusion: This review provided evidence that sirolimus is a promising treatment option for controlling inflammatory activity, improving visual acuity, and sparing CS use with minor adverse events for NIU. Keywords: non-infectious uveitis, immunosuppression, corticosteroid-sparing, sirolimus, mTOR inhibitors, uveitis treatment, vitreous hazeCabahug VLOUy HSYu-Keh ESapno KJDDove Medical PressarticleNon-infectious uveitisImmunosuppressionCorticosteroid-sparingSirolimusmTOR inhibitorsuveitis treatmentOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 13, Pp 649-669 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	Non-infectious uveitis Immunosuppression Corticosteroid-sparing Sirolimus mTOR inhibitors uveitis treatment Ophthalmology RE1-994
spellingShingle	Non-infectious uveitis Immunosuppression Corticosteroid-sparing Sirolimus mTOR inhibitors uveitis treatment Ophthalmology RE1-994 Cabahug VLO Uy HS Yu-Keh E Sapno KJD Outcomes of treatment with sirolimus for non-infectious uveitis: a meta-analysis and systematic review
description	Vicente Lorenzo O Cabahug,1 Harvey S Uy,1,2 Ellen Yu-Keh,1 Kristine Joy D Sapno3 1St Luke’s Medical Center, Quezon City, Philippines; 2University of the Philippines, Manila, Philippines; 3University of Santo Tomas Hospital, Manila, Philippines Background: Uveitis is a group of intraocular inflammatory diseases whose primary treatment involves immunosuppression. Although corticosteroids (CSs) remain the mainstay therapy, sirolimus is among the recently studied immunomodulatory drugs for treating noninfectious uveitis (NIU).Objective: The aim of this review was to assess and summarize the updated evidence on the outcomes of treatment with sirolimus for NIU.Materials and methods: Two reviewers conducted a systematic search on November 5, 2018, of electronic databases (EMBASE, MEDLINE, and The Cochrane Library) and clinical trial registers having no restrictions on language or publication date. The primary outcome was uveitis activity as measured by vitreous haze (VH), while the secondary outcomes included central macular thickness (CMT), best-corrected visual acuity (BCVA), CS-sparing effect, IOP elevation, and other adverse events. A meta-analysis was conducted on selected studies with appropriate clinical and methodological homogeneity.Results: Seven studies were included and reviewed. Four randomized clinical trials were eligible for meta-analysis: SAVE 2013, One-year outcomes of the SAVE study, SAVE 2 2016, SAKURA 2016. The pooled proportions of inflammation control (VH improvement) were 38% (95% CI 16.19%–62.66%) during a 6-month follow-up and 49.97% (95% CI 16.19%–83.03%) during a 6- to 12-month follow-up with the latter showing a significantly higher response rate (p=0.0472). BCVA improvement was 62.2% (95% CI 33.17%–87.11%) during a 6-month follow-up and 56.86% (95% CI 20.91%–89.05%) during a 6- to 12-month follow-up with no significant difference between the two (p=0.3705). Increased IOP remained at 7.11% (95% CI 3.46%–12.68%) for both a 6-month follow-up and up to a 12-month follow-up duration. The CS-sparing effect of sirolimus was also well demonstrated. A reduction in CMT was observed, and only minor drug-related adverse events were reported in all the studies reviewed.Conclusion: This review provided evidence that sirolimus is a promising treatment option for controlling inflammatory activity, improving visual acuity, and sparing CS use with minor adverse events for NIU. Keywords: non-infectious uveitis, immunosuppression, corticosteroid-sparing, sirolimus, mTOR inhibitors, uveitis treatment, vitreous haze
format	article
author	Cabahug VLO Uy HS Yu-Keh E Sapno KJD
author_facet	Cabahug VLO Uy HS Yu-Keh E Sapno KJD
author_sort	Cabahug VLO
title	Outcomes of treatment with sirolimus for non-infectious uveitis: a meta-analysis and systematic review
title_short	Outcomes of treatment with sirolimus for non-infectious uveitis: a meta-analysis and systematic review
title_full	Outcomes of treatment with sirolimus for non-infectious uveitis: a meta-analysis and systematic review
title_fullStr	Outcomes of treatment with sirolimus for non-infectious uveitis: a meta-analysis and systematic review
title_full_unstemmed	Outcomes of treatment with sirolimus for non-infectious uveitis: a meta-analysis and systematic review
title_sort	outcomes of treatment with sirolimus for non-infectious uveitis: a meta-analysis and systematic review
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/f6bdb4b0eaa2440883c96a7c989706f1
work_keys_str_mv	AT cabahugvlo outcomesoftreatmentwithsirolimusfornoninfectiousuveitisametaanalysisandsystematicreview AT uyhs outcomesoftreatmentwithsirolimusfornoninfectiousuveitisametaanalysisandsystematicreview AT yukehe outcomesoftreatmentwithsirolimusfornoninfectiousuveitisametaanalysisandsystematicreview AT sapnokjd outcomesoftreatmentwithsirolimusfornoninfectiousuveitisametaanalysisandsystematicreview
_version_	1718400330109026304

Outcomes of treatment with sirolimus for non-infectious uveitis: a meta-analysis and systematic review

Ejemplares similares