The severe side effects of steroid therapy preclude the use of these drugs over the long term, and necessitate other drugs to decrease or eliminate the need for long term steroid therapy. These drugs suppress or modulate the immune system. Many of these agents were initially developed to treat cancer, but when administered in small doses can be effective in treating inflammation of the joints, skin or eyes. Other drugs are used in the setting of organ transplants, but their immunomodulatory effects can be employed in treating ocular inflammation.
When considering immunomodulatory therapy, it is critical to remember: 1) the onset of action may be anywhere between 3 to 8 weeks, during which time patients often need to continue steroid therapy; 2) not all drugs may work for a given patient’s inflammation, and it may be necessary to change drugs or try more than one at a time in order to determine which regimen works best; 3) these drugs have side effects that can be fatal if ignored, so that careful monitoring is essential while these drugs are being used. This monitoring may include testing the blood for liver, kidney or bone marrow dysfunction, testing the urine for bladder toxicity, and monitoring blood pressure, depending on the agents used. With this in mind, patient cooperation and adherence to the drug dosing and monitoring regimen is essential if these drugs are to be used.
Immunomodulatory agents frequently used in treating ocular inflammatory diseases include METHOTREXATE, MYCOPHENOLATE MOFETIL, CYCLOSPORINE, CYCLOPHOSPHAMIDE (CYTOXAN), INFLIXIMAB (REMICADE), ADALIMUMAB (HUMIRA).