The use of immunosuppressive agents in the treatment of uveitis

  A patient who had nodular disease for more than 10 years started to have vision loss 1 year ago and was diagnosed with uveitis. The outside doctor gave hormonal eye drops to spot the eyes, but the condition continued to worsen. The patient had a perennial cough due to nodular disease and also had difficulty sleeping at night due to cough and chest tightness. He had previously taken hormone therapy for nodular disease, but the treatment was ineffective and continued to worsen after stopping the medication. We gave a small dose of hormone combined with cyclosporine treatment, and the patient’s vision quickly improved from 0.1 to 0.5, and the cough was completely controlled, and the quality of life improved dramatically. The biweekly lab tests were in the normal range. At the follow-up appointment today, the patient is confident and relieved that his condition is under control.  The drugs commonly used to treat uveitis are hormones and immunosuppressants, and cyclosporine is one of the classes of immunosuppressants. The mention of immunosuppressants can be very scary for many patients and even doctors. Hormones are the most commonly used medication for uveitis, but they can have many side effects for patients who need long-term treatment, and can seriously affect growth and development in children; in addition, for many types of total or posterior uveitis, hormone therapy alone is often not as effective as it could be, and reduction or discontinuation of the drug can easily lead to relapse. Therefore, in order to enhance the efficacy and reduce the side effects, the mainstay of international treatment for chronic recurrent autochthonous uveitis is the combination of hormones and immunosuppressants, which can reduce the amount of hormones and avoid the side effects of using larger doses of one drug, and also enhance the efficacy and facilitate long-term control of the disease. Commonly used immunosuppressive agents include cyclosporine, methotrexate, azelaic acid, cyclophosphamide, azathioprine and mescaline. Each immunosuppressant is appropriate for a different type of uveitis and has different side effects. When choosing an immunosuppressant, the patient’s type of uveitis and physical condition need to be fully considered. The doses of immunosuppressants used for the treatment of uveitis are usually small. For example, cyclosporine may be used at a dosage of 300 mg/day or more for other systemic diseases, whereas we commonly use only 100-150 mg/day, which can be well tolerated by most patients. As long as the characteristics of each immunosuppressant are well grasped, the right indications are chosen, and blood indicators are regularly tested, the desired therapeutic effect can be achieved.