Abstract
The purpose of this study is to review the literature on the risk of malignancy in patients with inflammatory eye disease (IED) treated with systemic immunosuppressive (IS) therapy. Relevant databases in transplant medicine, autoimmune diseases and literature regarding uveitis and scleritis were reviewed. Literature with regards systemic IS therapy in transplant recipients and patients with autoimmune diseases revealed a significant increase in malignancies, especially non-melanocytic skin cancers and lymphomas. Studies of patients with IED were limited in number and scope, with no studies adequately evaluating the incidence of malignancy in these patients. Difficulties associated with the evaluation of the risk of malignancy associated with IS therapy in patients with IED include the heterogeneity of the disease and treatment regimens as well as the low frequency of IED, its variable severity and the lack of adequate long-term follow-up studies. Systemic IS therapy is an important therapeutic option in the treatment of patients with severe IED. A well-designed, comprehensive, multi-centre long-term follow-up study is required to evaluate the risk of malignancy in patients with specific IED diseases treated with defined systemic IS therapy. Until such evidence is available, we recommend the adoption of preventative strategies to help minimise the risk of malignancy in such patients.
Highlights
The aims of therapy in patients with inflammatory eye disease (IED) are to control ocular inflammation, limit the progression of disease, preserve vision, maintain the quality of life and prevent local and systemic side effects
The treatment of severe IED with immunosuppressive (IS) therapy is a dilemma for the physician in determining whether the benefits of such therapy outweigh the risk of inducing other diseases, such as infection and malignancy
The incidence of malignancy in patients treated with IS therapy differed depending on the specific IS agents and the indication for therapy
Summary
The aims of therapy in patients with inflammatory eye disease (IED) are to control ocular inflammation, limit the progression of disease, preserve vision, maintain the quality of life and prevent local and systemic side effects. The treatment of severe IED with immunosuppressive (IS) therapy is a dilemma for the physician in determining whether the benefits of such therapy outweigh the risk of inducing other diseases, such as infection and malignancy. The majority of evidence concerning the effects of IS therapy on the host immune response and tumour development is derived from studies of transplant recipients. The effectiveness of IS therapy in improving the outcome of organ transplantation has resulted in the development of malignancies and cardiovascular disease emerging as the major causes of patient mortality, rather than graft rejection as previously observed [1,3,6]. Patients with systemic inflammatory diseases are frequently treated with a number of immunosuppressive drugs, often concurrently and over a shorter time course, but may still be predisposed to increased tumour risk [7]
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