Anti-tubercular therapy in the treatment of tubercular uveitis: A systematic review and meta-analysis

Bjorn Kaijun Betzler, Ikhwanuliman Putera, Ilaria Testi, Rina La Distia Nora, John Kempen, Onn Min Kon, Carlos Pavesio, Vishali Gupta, Rupesh Agrawal

Research output: Contribution to journalReview articlepeer-review

2 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)241-256
Number of pages16
JournalSurvey of Ophthalmology
Volume68
Issue number2
DOIs
Publication statusAccepted/In press - 2022

Keywords

  • Anti-tubercular therapy
  • Corticosteroids
  • Inflammation
  • Meta-analysis
  • Ocular tuberculosis
  • Systematic review
  • Tubercular uveitis

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