National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
Expert Opin Emerg Drugs. 2011 Jun;16(2):309-22. doi: 10.1517/14728214.2011.537824. Epub 2011 Jan 6.
Uveitis is a challenging disease covering both infectious and noninfectious conditions. The current treatment strategies are hampered by the paucity of randomized controlled trials and trials comparing the efficacy of different agents.
This review describes the current and future treatments of uveitis. A literature search was performed in PUBMED from 1965 to 2010 on drugs treating ocular inflammation with emphasis placed on more recent, larger studies. Readers should gain a basic understanding of current treatment strategies beginning with corticosteroids and transitioning to steroid sparing agents. Steroid sparing agents include antimetabolites such as methotrexate, azathioprine and mycophenolate mofetil; calcineurin inhibitors which include cyclosporine, tacrolimus; alkylating agents which include cyclophosphamide and chlorambucil; and biologics which include the TNF-α inhibitors infliximab, adalimumab and etanercept and daclizumab, IFN-α(2a) and rituximab.
Newer agents are typically formulated from existing drugs or developed based on new advances in immunology. Future treatment will require a better understanding of the mechanisms involved in autoimmune diseases and better delivery systems in order to provide targeted treatment with minimal side effects.
葡萄膜炎是一种具有挑战性的疾病,涵盖了感染性和非感染性疾病。目前的治疗策略受到缺乏随机对照试验和比较不同药物疗效的试验的限制。
这篇综述描述了葡萄膜炎的当前和未来治疗方法。从 1965 年到 2010 年,在 PUBMED 上进行了文献检索,检索了治疗眼部炎症的药物,重点是最近的、更大规模的研究。读者应该对从皮质类固醇开始并过渡到类固醇保留剂的当前治疗策略有一个基本的了解。类固醇保留剂包括甲氨蝶呤、硫唑嘌呤和霉酚酸酯等抗代谢物;环孢素、他克莫司等钙调神经磷酸酶抑制剂;环磷酰胺、苯丁酸氮芥等烷化剂;以及 TNF-α 抑制剂英夫利昔单抗、阿达木单抗和依那西普和达克珠单抗、IFN-α(2a)和利妥昔单抗等生物制剂。
新型药物通常是基于现有药物的配方或根据免疫学的新进展开发的。未来的治疗需要更好地了解自身免疫性疾病中涉及的机制,并需要更好的输送系统,以便提供靶向治疗,副作用最小化。