Anti-tubercular therapy in the treatment of tubercular uveitis: A systematic review and meta-analysis |
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| Institution: | 1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore;2. Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Indonesia;3. Erasmus Medical Center, Rotterdam, The Netherlands;4. Moorfields Eye Hospital, London, United Kingdom;5. Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, United States;6. Myungsung Christian Medical Center (MCM) Eye Unit, MCM General Hospital and Myungsung Medical School, Addis Ababa, Ethiopia;7. Department of Ophthalmology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia;8. Chest and Allergy Clinic, St Mary''s Hospital, Imperial College Healthcare National Health Service Trust, London, England;9. Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India;10. National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore;11. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore;12. Singapore Eye Research Institute, Singapore;13. Duke-NUS Medical School, Singapore;1. Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore;2. Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India;3. Department of Renal Medicine, Tan Tock Seng Hospital, Singapore;4. Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;5. Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia;6. Singapore Eye Research Institute, Singapore;7. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore;8. Yong Loo Lin School of Medicine, National University of Singapore, Singapore;9. Duke NUS Medical School, Singapore;4. School of Material Science and Engineering, Nanyang Technological University, Singapore, Republic of Singapore;15. Byers Eye Institute, Stanford Medical School, Stanford, California;1. Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia;2. Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands;3. Moorfields Eye Hospital, NHS Foundation Trust, London, UK;4. University College London Institute of Ophthalmology, London, UK;5. Singapore National Eye Centre, Singapore;6. Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore;7. Postgraduate Institute of Medical Education and Research, Chandigarh, India;8. Department of Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore;9. Singapore Eye Research Institute, Singapore;10. National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore;11. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore |
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| Abstract: | We quantitatively evaluated the efficacy of antitubercular therapy (ATT) in tubercular uveitis (TBU) patients. Main outcome measures include inflammation recurrence, inflammation reduction, complete resolution of inflammation, improved visual acuity (VA), ability to taper corticosteroids to < 10 mg/day without inflammatory progression, and use of adjunctive immunosuppressants while on ATT. This review is prospectively registered in PROSPERO (CRD42020206845). Forty-nine studies reporting data for 4,017 TBU patients were included. In comparative studies, the odds ratio (OR) of inflammatory recurrence was 0.33 (95%CI:0.19-0.60) for TBU patients treated with ATT±corticosteroid versus no ATT. For TBU patients treated with ATT±corticosteroid, the pooled absolute incidences of inflammatory recurrence, inflammatory reduction, complete resolution of inflammation, and visual acuity improvement were 13% (n=310/2,216; 95%CI:9-18), 81% (n=217/276; 95%CI: 62-95), 83% (n=1,167/1,812; 95%CI: 77-89), and 65% (n=347/542; 95%CI:51-78), respectively. Corticosteroids were tapered to <10 mg/day without inflammatory progression in 91% (n=326/395; 95%CI:78-99) of patients, 9% (n=121/1,376; 95%CI:6-13) of whom were administered concomitant immunosuppressive agents alongside ATT. We conclude that treatment of TBU with ATT±corticosteroid is associated with a high level of control or improvement of inflammation. More prospective studies with detailed reporting of ATT regimens, patient subgroups, and outcomes are required to better evaluate ATT effectiveness. |
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