tacrolimus and Uveitis--Intermediate

To evaluate the responsiveness of the Vision core module 1 (VCM1) vision-related quality of life (VR-QOL) questionnaire to changes in visual acuity in patients with posterior and intermediate uveitis and to validate its use as a clinical end point in uveitis.. Logarithm of the minimum angle of resolution visual acuity and VR-QOL using the VCM1 questionnaire were prospectively recorded in 37 patients with active posterior segment intraocular inflammation before starting systemic immunosuppression with ciclosporin, tacrolimus or the anti-tumour necrosis factor (TNF) agent, p55TNFr-Ig, and again 3 months later. Spearman analysis was used to correlate improvements in visual acuity and VR-QOL between baseline and 3 months.. The correlation between changes in visual acuity and VR-QOL was moderate to good for the worse eye (r = 0.47, p = 0.003), but poor for the better eye (r = -0.05, p = 0.91). The responsiveness indices effect size and standardised response mean were 0.57 and 0.59, respectively, showing that the VCM1 questionnaire is moderately responsive to immunsosuppressive therapy for active uveitis.. Changes in VR-QOL measured with the VCM1 questionnaire correlated moderately well with changes in the worse eye visual acuity, suggesting that the VCM1 is a valid instrument for monitoring response to treatment in uveitis.

Topics: Adult; Aged; Cyclosporine; Female; Health Status Indicators; Humans; Immunosuppressive Agents; Male; Middle Aged; Quality of Life; Severity of Illness Index; Surveys and Questionnaires; Tacrolimus; Treatment Outcome; Tumor Necrosis Factor-alpha; Uveitis, Intermediate; Uveitis, Posterior; Visual Acuity

To compare the efficacy and tolerability of tacrolimus and cyclosporine therapy for noninfectious posterior segment intraocular inflammation and to evaluate their effect on peripheral blood CD4(+) T-cell phenotype and activation status.. Thirty-seven patients who required second-line immunosuppression for posterior segment intraocular inflammation were enrolled in this prospective randomized trial of tacrolimus vs cyclosporine therapy. The main outcome measures were visual acuity, binocular indirect ophthalmoscopy score, adverse effects, and quality of life. In addition, peripheral blood CD4(+) T-cell phenotype and activation status were evaluated by flow cytometry before treatment and at 2, 4, and 12 weeks using CD69, chemokine receptor (CCR4, CCR5, and CXCR3), and intracellular cytokine (tumor necrosis factor alpha, interferon-gamma, and interleukin 10) expression.. Thirteen patients (68%) taking tacrolimus and 12 patients (67%) taking cyclosporine responded to treatment. Cyclosporine therapy was associated with a higher incidence of reported adverse effects. Mean arterial pressure and serum cholesterol level were significantly higher at 3 months in the cyclosporine group than the tacrolimus group. No significant difference was detected with regard to effect on quality of life or CD4(+) T-cell phenotype.. Tacrolimus and cyclosporine were similar with regard to efficacy for posterior segment intraocular inflammation, but the results suggested a more favorable safety profile for tacrolimus therapy.

Topics: Adult; Antigens, CD; Antigens, Differentiation, T-Lymphocyte; Blood Pressure; CD4-Positive T-Lymphocytes; Cholesterol; Cyclosporine; Cytokines; Female; Flow Cytometry; Humans; Immunophenotyping; Immunosuppressive Agents; Lectins, C-Type; Lymphocyte Activation; Male; Middle Aged; Prospective Studies; Quality of Life; Tacrolimus; Treatment Outcome; Uveitis, Intermediate; Uveitis, Posterior; Visual Acuity

Topics: Cyclosporine; Humans; Immunosuppressive Agents; Randomized Controlled Trials as Topic; Tacrolimus; Uveitis, Intermediate; Uveitis, Posterior