Author Interviews, JAMA, Ophthalmology / 08.05.2017
Study Compares Systemic Therapy vs Ocular Implant For Uveitis
MedicalResearch.com Interview with:
John H Kempen, MD, PhD
Protocol Chair, MUST Trial Follow-up Study; Vice Chair, MUST Research Group
Director of Epidemiology for Ophthalmology, Massachusetts Eye and Ear
Harvard Medical School
Editor-in-Chief, Ophthalmic Epidemiology
President, Sight for Souls
MedicalResearch.com: What is the background for this study?
Response: Uveitis is about the fifth leading cause of blindness in the united states. Among types of uveitis, intermediate, posterior and panuveitis are the leading causes of blindness. Before 2005, systemic therapy with corticosteroids—supplemented when indicated with immunosuppressive drugs (most of the time)—was the primary treatment recommended for these conditions. With approval of the fluocinolone acetonide implant in 2005 for intermediate, posterior and panuveitis, it became unclear which of the alternative treatment approaches should be the treatment of choice.
The multicenter uveitis steroid treatment (must) trial was initiated in 2005 to directly compare the alternative treatments. Systemic therapy was administered using high dose prednisone followed by tapering of corticosteroids to maintenance doses of 10 mg/day or less (generally 7.5 mg/day or less) or to zero; this was supplemented by immunosuppressive corticosteroid-sparing drugs in 88% of participants. Implant therapy was done by initial quieting of the anterior chamber of the eye with topical, injected or systemic corticosteroids followed by surgical implant placement within 28 days (first eye) and 56 days (second eye if it was indicated). After this, systemic corticosteroids and immunosuppressive drugs were tapered off.
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