Table 1.
Mechanisms and side-effects of selected treatments for pediatric uveitis
| Category | Drug (trade name) | Mechanism of action | Side-effects |
|---|---|---|---|
| Glucocorticoid | Deltasone (Prednisone) | Multiple mechanisms | Cataracts, weight gain, stunted growth (children), acne, osteoporosis |
| Antimetabolites | Methotrexate (Trexall) | Inhibits dihydrofolate reductase | Bone marrow suppression, stomatitis, hair loss, hepatotoxicity |
| Azathioprine (Imuran) | A purine nucleoside analogue that interferes with DNA and RNA synthesis | Bone marrow suppression, gastrointestinal symptoms | |
| Mycophenolate mofetil (Cellcept) | Inhibits inosine monophosphate dehydrogenase | Diarrhea, nausea, neutropenia, infection | |
| T-cell inhibitors | Cyclosporine (Neoral, Sandimmune, Gengraf) | Calcineurin inhibitor | Nephrotoxicity, tremor, hirsutism, gum hyperplasia, hypertension |
| a Voclosporin | Hypertension, decreased renal function, pyrexia, arthralgia [10] | ||
| Tacrolimus (Prograf) | Nephrotoxicity, hypertension, neurotoxicity, hepatitis, diabetes | ||
| a Sirolimus (Rapamune) | Inhibits mTOR pathway | Nephrotoxicity, hypersensitivity reaction, peripheral edema, hypertriglyceridemia, hypertension, hypercholesterolemia, thrombocytopenia | |
| Alkylating agents | Chlorambucil (Leukeran) | DNA crosslinking | Bone marrow suppression, malignancy, sterility, infection |
| Cyclophosphamide (Cytoxan) | Bone marrow suppression, hemorrhagic cystitis, malignancy, sterility, alopecia, infection | ||
| Biologics | Infliximab (Remicade) | TNF inhibitor | Infection, tuberculosis, lymphoma, autoantibodies, demyelinating disease, worsening heart failure; local skin reaction at injection site (golimumab, adalimumab) |
| a Adalimumab (Humira) | |||
| Golimumab (Simponi) | |||
| Certolizumab pegol (CIMZIA) | |||
| Etanercept (Enbrel) | |||
| Anakinra (Kineret) | Anti-IL1R | Injection site reaction, infection | |
| Canakinumab (Ilaris) | Anti-IL1β Ab | Injection site reaction, infection | |
| Daclizumab (Zenapax) | Anti-IL2R Ab | Infection, lymphoproliferative disorder, severe hypersensitivity reactions; Note: No longer commercially available | |
| a Tocilizumab (Actemra) | Anti-IL6R Ab | Infection, hypercholesterolemia, infusion-related reaction | |
| Rituximab (Rituxan) | CD20R Ab | Infection, infusion-related reaction, neutropenia | |
| Abatacept (Orencia) | T-cell costimulation inhibitor | Infection, malignancy | |
| Intravitreal corticosteroid implants | Dexamethasone (Ozurdex) | Multiple mechanisms | Significant IOP increase, cataract formation (less than fluocinolone acetate) |
| Fluocinolone acetonide (Retisert) | Multiple mechanisms | Significant IOP increase and cataract formation |
Ab, antibody; mTOR, mammalian target of rapamycin; R, receptor.
a
Potential compounds for the treatment of uveitis (clinicaltrials.gov).