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jurnal uveitis by CharlesSaputra

VIEWS: 68 PAGES: 23

									                           Journal Reading:

The Multicenter Uveitis Steroid Treatment Trial:
Rationale, Design, and Baseline Characteristics
      The Multicenter Uveitis Steroid Treatment Trail Research Group


                                 Pembimbing:
                            dr.Agah Gadjali, SpM
                            dr.Hermansyah, SpM
                            dr.Gartati Ismail,SpM
                               dr.Mustafa, SpM
                             dr.Henry A W, SpM

                                   Penyaji:
                       Bertha Berliana (2009-061-011)
                      Erman Muliawan (2009-061-012)
                     Ronald Christian A.(2009-061-013)
                        Dessy Natalia (2009-061-143)


                     Periode 19 Juli 2010-31 Juli 2010
                  Kepaniteraan Klinik Ilmu Penyakit Mata
        Fakultas Kedokteran Universitas Katolik Indonesia Atma Jaya
                Introduction
• Uveitis or intraocular inflammation causes
  10% of cases blindness in the US and being
  the fifth, sixth, or seventh leading cause of
  blindness in various study.
• Uveitis often strikes at a younger age than
  common age-related eye disorders.
                 Introduction
• Uveitis can be classified into anteroir uveitis,
  intermediate uveitis, posterior uveitis or
  panuveitis
                  Introduction
• In United States, most intermediate uveitis,
  panuveitis and one half of posterior uveitis cases are
  presumed to be autoimmune
• Use of systemic corticosteroids (with
  immunosuppresive drugs when indicated) historically
  has been the primariy method advocated for control
  severe cases of uveitis.
                  Introduction
• The fluocinolone acetonide implant is designed to be
  effective in controlling uveitis and for the medium or
  longterm management
                Introduction
• RCT direcly comparing these alternatives for
  the management of noninfectious uveitis.
• This report describes the design of the trial
  and the baseline characteristics of the patients
  enrolled into the trial.
                  Methods
• Multicenter Uveitis Steroid Treatment (MUST)
  trial :
  – Comparing therapy with fluocinolone acetonide
    implant vs systemic therapy with oral
    corticosteroids and immunosuppresive drugs.
  – For patients with severe noninfectious
    intermediate uveitis, posterior uveitis, or
    panuveitis.
                    Methods
• Overall goal :
  – To ascertain the relative benefits and risks of the
    alternative therapies and the incremental cost-
    effectiveness of the 2 treatment approaches.
                    Methods
• Specific aims :
  1. To compare visual outcomes
  2. To compare effectiveness of these treatment for
     controlling uveitis and avoiding the
     accumulation of complications
  3. To compare rates of both ocular and systemic
     side effects
  4. To compare quality of life between treatment
     strategies
                    Methods
• Description :
  – MUST trial is designed to detect a difference
    between randomly assigned treatment groups of
    7.5 letters (1.5 lines) in mean change in logMAR
    visual acuity from baseline to follow up at 2 years
  – Sample size : 255 patients who had active or
    recently active (within 60 days) intermediate
    uveitis, posterior uveitis, or panuveitis.
                   Methods
• Implant therapy :
  – Fluocinolone acetonide 0.59 mg
  – Study-certified surgeon with standard technique
• Systemic therapy :
  – Oral corticosteroid therapy (Prednisone 1 mg/kg
    per day up to maximum 60 mg/day)
  – Immunosuppresive drugs
                       Methods
• Primary goal : Preserve vision
• Evaluated outcomes :
  –   Best-corrected visual acuity
  –   Intraocular inflammation
  –   Ocular complications of uveitis or of therapy
  –   Systemic complications of therapy
  –   Self-reported quality of life
  –   Imaging studies
  –   Health-related quality of life (EuroQol 5-dimension,
      Visual Analog Score, National Eye Institute Visual
      Function Questionnaire)
Results
Results
Results
Results
Results
Results
Results
                      Discussion
               Implant therapy        Systemic therapy

Benefits    Highly effective for   • Lower incidence of
           control of inflammation local complication
           overlong periods        • more comprehensively
                                   the autoimmunity


Side       • High incidence of    • More systemic side
effects    cataract               effect
           •↑ IOP                 • More relapses on
                                  inflammation
                  Discussion
• Baseline observation from the MUST trial :
  – Systemic inflammatory disease is less common
    associated with intermediate uveitis
  – Nearly 10% had osteoporosis at baseline
  – High prevalence of reduced visual acuity and
    ocular comlications of uveitis → reduced quality of
    life
  – Lens opacities were common in intermediate,
    posterior, and panuveitis → high risk of cataract in
    severe uveitis cases
                  Discussion
• Limitations of the study design :
  – Heterogeneity of the forms of uveitis involving the
    posterior segment → heterogenous in response to
    the treatments
  – Patients are being enrolled at tertiary uveitis
    center where treatments of this nature often are
    administrated → more severe cases were enrolled

								
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