[Therapeutics for future treatment of uveitis]

The increased knowledge in immunology and the progresses of pharmacology have improved our treatment of autoimmune diseases. The main anti-inflammatory effects of corticosteroids are an attenuation of the hypersensibility reactions, a sequestration of intravascular lymphocytes and an inhibition of the production of cytokines and eicosanoids. The non-steroidal anti-inflammatory drugs (NSAID's) form another group of medications particularly useful for the treatment of chronic uveitis. Several Cox-2 inhibitory medications are at the moment under clinical investigation and some are commercially available. One of their characteristics is to present less of the most undesirable side effects seen with conventional NSAID's like irritation of the gastro-intestinal tractus and platelets aggregation inhibition. Agents like cyclophosphamide, leukeran, imuran, methotrexate and cyclosporin have been used extensively for the treatment of severe uveitis. Because of its efficacy and safety, methotrexate is the best immunosuppressive agent to be tried for the treatment of chronic uveitis. However, immunosuppressive treatments and corticosteroids have many side effects and are not very selective. To improve our therapeutic arsenal, other treatments are being investigated for the treatment of severe uveitis. Manipulations of cytokines expression by Th1 lymphocytes will be one of then.