Long-term immunosuppressive therapy for inflammatory eye disease – the link between systemic treatment, cardiovascular risk and disease?

ABSTRACT

Introduction: Inflammatory eye diseases (IED), which encompasses uveitis and scleritis, often require systemic immunosuppressive therapy (IMT) to induce disease control or remission. Immunosuppressive therapy, including glucocorticoids, has been implicated in accelerating atherosclerosis and increasing cardiovascular morbidity and mortality in patients with rheumatic diseases or solid organ transplant recipients.

Areas covered: Literature review conducted with the use of PubMed, MEDLINE and Cochrane library for peer reviewed articles then stratified for strength of evidence in reference to traditional risk factors such as hypertension, lipid profile and insulin resistance. Evidence of cardiovascular events were included. Commonly used immunosuppressive agent used in the treatment of IED including azathioprine, methotrexate, mycophenolate, cyclosporine, tacrolimus and the biologics. Each immunosuppressive agent was considered in terms of effects on hypertension, lipid profile, insulin resistance and cardiovascular outcomes.

Expert commentary: Cyclosporine is associated with increased risk of hypertension and tacrolimus with insulin resistance. There is little evidence of cardiovascular disease with the use of methotrexate, azathioprine or mycophenolate. There is some evidence that the newer biologics may have protective effects on cardiovascular parameters. However, there is heterogeneity of the study populations and limited evidence in the ophthalmological setting.

KEYWORDS:

• Immunosuppressive therapy
• cardiovascular disease
• atherosclerosis
• inflammatory eye disease

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.