What is it about?
Sirolimus is among many immunomodulator drugs used in medicine. It has potential applications in eye diseases specifically, uveitis. This paper examines all the available data regarding this drug to come up with a general conclusion in terms of its safety and efficacy. To date, sirolimus appears to be beneficial in treating patients with non-infectious uveitis.
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Why is it important?
While uveitis may be an unheard eye condition to the layperson, according to some studies, it actually is the 3rd leading cause of preventable blindness in the world. Treatment with corticosteroids is readily available however limitations to its use stem from complications due to prolonged use. Thus, alternative therapy includes a variety of immunomodulator drugs. The most optimal choice of which is one that is both effective and tolerable. Current evidence suggests that sirolimus may be a potential candidate favored by the recent clinical trials we have analyzed.
Read the Original
This page is a summary of: Outcomes of treatment with sirolimus for non-infectious uveitis: a meta-analysis and systematic review, Clinical Ophthalmology, April 2019, Dove Medical Press, DOI: 10.2147/opth.s198401.
You can read the full text:
OUTCOMES OF TREATMENT WITH SIROLIMUS FOR NON-INFECTIOUS UVEITIS
This is a video abstract of the study. 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.
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