Oftalmolojide İmmünomodülatör Ajanların Kullanımı ve
COVID-19

YALÇINDAĞ, FATİME NİLÜFER; Tugal-Tutkun, Ilknur; Değirmenci, Mehmet Fatih Kağan

doi:10.4274/tjo.galenos.2021.68252

Oftalmolojide İmmünomodülatör Ajanların Kullanımı ve COVID-19

Mehmet Fatih Kağan DEĞİRMENCİ, (Çankırı Devlet Hastanesi, Göz Hastalıkları Kliniği, Çankırı, Türkiye)

FATİME NİLÜFER YALÇINDAĞ, (Ankara Üniversitesi Tıp Fakültesi, Göz Hastalıkları Anabilim Dalı, Ankara, Türkiye)

İlknur TUĞAL TUTKUN (İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Göz Hastalıkları Anabilim Dalı, İstanbul, Türkiye)

Türk Oftalmoloji Dergisi

2 1

Yıl: 2021 Cilt: 51 Sayı: 4 Sayfa Aralığı: 231 - 242 Metin Dili: Türkçe DOI: 10.4274/tjo.galenos.2021.68252 İndeks Tarihi: 04-06-2022

Oftalmolojide İmmünomodülatör Ajanların Kullanımı ve COVID-19

Öz:

İmmünomodülatör ilaçlar sıklıkla non-enfeksiyöz üveitlerin sistemik tedavisinde kullanılmaktadır. Bu ilaçlar kortikosteroidler, konvansiyonel immünosupresifler ve biyolojik ajanlardan oluşmaktadır. İmmün sistemi baskıladıkları için bilindiği üzere en önemli sorun immünomodülatör tedaviye (İMT) bağlı olarak enfeksiyon riskinin artmasıdır. Dünya Sağlık Örgütü, 11 Mart 2020 tarihinde koronavirüs hastalığı-19 (COVID-19) hastalığını pandemik olarak ilan etmiştir. Tüm insanlarda SARS-CoV-2 enfeksiyonuna sekonder şiddetli akut respiratuvar distres sendromu gelişebilecek olmasına rağmen İMT alan hastalar hem enfeksiyonun bulaşı hem de hastalığın daha ağır seyretmesi açısından daha fazla risk altında olabilirler. Bu nedenle pandemi sürecinde üveit nedeniyle İMT alan hastaların yönetimi ile ilgili kılavuzlara ihtiyaç vardır. Bu derlemede üveit tedavisinde kullanılan immünomodülatör ilaçlar enfeksiyöz komplikasyonlar açısından incelenmiş ve COVID-19 pandemisi sürecinde İMT uygulanan hastalara ait veriler ve bu ilaçların kullanımı ile ilgili öneriler irdelenmiştir. En son elde edilen bilgiler ışığında, düzenli olarak tam kan sayımı (özellikle beyaz küre sayısı >4.000/ µL olmalı) ile karaciğer ve böbrek fonksiyon testlerini aksatmamaları koşuluyla İMT kullanan hastaların tedavilerine devam edebileceği bildirilmektedir. COVID-19 tanısı alan hastaların ise multidisipliner bir yaklaşımla yönetilmesi gerektiği bildirilmektedir

Anahtar Kelime:

COVID-19 and the Use of Immunomodulatory Agents in Ophthalmology

Öz:

Immunomodulatory agents are often used in the systemic treatment of non-infectious uveitis. These drugs consist of corticosteroids, conventional immunosuppressives, and biological agents. As it is known that they suppress the immune system, the most important concern associated with immunomodulatory therapy (IMT) is the increased risk of infection. The World Health Organization declared COVID-19 a pandemic on 11 March 2020. Although severe acute respiratory distress syndrome secondary to SARS-CoV-2 infection may develop in all people, patients who receive IMT may be at higher risk in terms of both the transmission of the infection and more severe disease course. Therefore, guidelines on the management of patients receiving IMT due to uveitis during the pandemic are needed. In this review, we examined the immunomodulatory drugs used in the treatment of uveitis in terms of infectious complications and the data of patients who received IMT during the COVID-19 pandemic and discussed recommendations for the use of these drugs. According to the latest information, patients who receive IMT may continue their treatment as long as there are no disruptions in regular complete blood count (especially white blood cell count >4,000/µL) and liver and kidney function tests. Patients diagnosed with COVID-19 should be managed with a multidisciplinary approach.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık

1. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, Wang W, Song H, Huang B, Zhu N, Bi Y, Ma X, Zhan F, Wang L, Hu T, Zhou H, Hu Z, Zhou W, Zhao L, Chen J, Meng Y, Wang J, Lin Y, Yuan J, Xie Z, Ma J, Liu WJ, Wang D, Xu W, Holmes EC, Gao GF, Wu G, Chen W, Shi W, Tan W. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395:565-574.
2. Li H, Zhou Y, Zhang M, Wang H, Zhao Q, Liu J. Updated Approaches against SARS-CoV-2. Antimicrob Agents Chemother. 2020;64:e00483.
3. Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020;395:473- 475.
4. Luo P, Liu Y, Qiu L, Liu X, Liu D, Li J. Tocilizumab treatment in COVID-19: A single center experience. J Med Virol. 2020;92:814-818.
5. Praveen D, Puvvada RC, M VA. Janus kinase inhibitor baricitinib is not an ideal option for management of COVID-19. Int J Antimicrob Agents. 2020;55:105967.
6. Baud D, Qi X, Nielsen-Saines K, Musso D, Pomar L, Favre G. Real estimates of mortality following COVID-19 infection. Lancet Infect Dis. 2020;20:773.
7. Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, Ji R, Wang H, Wang Y, Zhou Y. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020;94:91-95.
8. Kim SW, Kim SM, Kim YK, Kim JY, Lee YM, Kim BO, Hwangbo S, Park T. Clinical Characteristics and Outcomes of COVID-19 Cohort Patients in Daegu Metropolitan City Outbreak in 2020. J Korean Med Sci. 2021;36:e12.
9. Farsalinos K, Barbouni A, Niaura R. Systematic review of the prevalence of current smoking among hospitalized COVID-19 patients in China: could nicotine be a therapeutic option? Intern Emerg Med. 2020;15:845-852.
10. Zhu L, Xu X, Ma K, Yang J, Guan H, Chen S, Chen Z, Chen G. Successful recovery of COVID-19 pneumonia in a renal transplant recipient with longterm immunosuppression. Am J Transplant. 2020;20:1859-1863.
11. Guillen E, Pineiro GJ, Revuelta I, Rodriguez D, Bodro M, Moreno A, Campistol JM, Diekmann F, Ventura-Aguiar P. Case report of COVID-19 in a kidney transplant recipient: Does immunosuppression alter the clinical presentation? Am J Transplant. 2020;20:1875-1878.
12. Liu B, Wang Y, Zhao Y, Shi H, Zeng F, Chen Z. Successful treatment of severe COVID-19 pneumonia in a liver transplant recipient. Am J Transplant. 2020;20:1891-1895.
13. Gianfrancesco M, Hyrich KL, Al-Adely S, Carmona L, Danila MI, Gossec L, Izadi Z, Jacobsohn L, Katz P, Lawson-Tovey S, Mateus EF, Rush S, Schmajuk G, Simard J, Strangfeld A, Trupin L, Wysham KD, Bhana S, Costello W, Grainger R, Hausmann JS, Liew JW, Sirotich E, Sufka P, Wallace ZS, Yazdany J, Machado PM, Robinson PC; COVID-19 Global Rheumatology Alliance. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis. 2020;79:859-866.
14. Henderson LA, Zurakowski D, Angeles-Han ST, Lasky A, Rabinovich CE, Lo MS; Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry Investigators. Medication use in juvenile uveitis patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J. 2016;14:9.
15. Ibrahim A, Ahmed M, Conway R, Carey JJ. Risk of Infection with Methotrexate Therapy in Inflammatory Diseases: A Systematic Review and Meta-Analysis. J Clin Med. 2018;8:15.
16. Russell B, Moss C, George G, Santaolalla A, Cope A, Papa S, Van Hemelrijck M. Associations between immune-suppressive and stimulating drugs and novel COVID-19-a systematic review of current evidence. Ecancermedicalscience. 2020;14:1022.
17. Arevalo JF, Lasave AF, Al Jindan MY, Al Sabaani NA, Al-Mahmood AM, Al-Zahrani YA, Al Dhibi HA; KKESH Uveitis Survey Study Group; KKESH Uveitis Survey Study Group. Uveitis in Behçet disease in a tertiary center over 25 years: the KKESH Uveitis Survey Study Group. Am J Ophthalmol. 2015;159:177-184.
18. Lodhi SA, Reddy JL, Peram V. Clinical spectrum and management options in Vogt-Koyanagi-Harada disease. Clin Ophthalmol. 2017;11:1399-1406.
19. Goebel JC, Roesel M, Heinz C, Michels H, Ganser G, Heiligenhaus A. Azathioprine as a treatment option for uveitis in patients with juvenile idiopathic arthritis. Br J Ophthalmol. 2011;95:209-213.
20. Seksik P, Cosnes J, Sokol H, Nion-Larmurier I, Gendre JP, Beaugerie L. Incidence of benign upper respiratory tract infections, HSV and HPV cutaneous infections in inflammatory bowel disease patients treated with azathioprine. Aliment Pharmacol Ther. 2009;29:1106-1113.
21. Blumentals WA, Arreglado A, Napalkov P, Toovey S. Rheumatoid arthritis and the incidence of influenza and influenza-related complications: a retrospective cohort study. BMC Musculoskelet Disord. 2012;13:158.
22. Thorne JE, Jabs DA, Qazi FA, Nguyen QD, Kempen JH, Dunn JP. Mycophenolate mofetil therapy for inflammatory eye disease. Ophthalmology. 2005;112:1472-1477.
23. Yalçindağ FN, Amer R, Forrester JV. Mycophenolate mofetil in the treatment of ocular inflammation in ANCA-associated vasculitis. J Ocul Pharmacol Ther. 2008;24:249-254.
24. Ritter ML, Pirofski L. Mycophenolate mofetil: effects on cellular immune subsets, infectious complications, and antimicrobial activity. Transpl Infect Dis. 2009;11:290-297.
25. Foster CS, Kothari S, Anesi SD, Vitale AT, Chu D, Metzinger JL, Cerón O. The Ocular Immunology and Uveitis Foundation preferred practice patterns of uveitis management. Surv Ophthalmol. 2016;61:1-17.
26. Berth-Jones J, Exton LS, Ladoyanni E, Mohd Mustapa MF, Tebbs VM, Yesudian PD, Levell NJ. British Association of Dermatologists guidelines for the safe and effective prescribing of oral ciclosporin in dermatology 2018. Br J Dermatol. 2019;180:1312-1338.
27. de Wilde AH, Raj VS, Oudshoorn D, Bestebroer TM, van Nieuwkoop S, Limpens RWAL, Posthuma CC, van der Meer Y, Bárcena M, Haagmans BL, Snijder EJ, van den Hoogen BG. MERS-coronavirus replication induces severe in vitro cytopathology and is strongly inhibited by cyclosporin A or interferon-α treatment. J Gen Virol. 2013;94:1749-1760.
28. Ghaffari Rahbar M, Nafar M, Khoshdel A, Dalili N, Abrishami A, Firouzan A, Poorrezagholi F, Samadian F, Ziaie S, Fatemizadeh S, Samavat S. Low rate of COVID-19 pneumonia in kidney transplant recipients-A battle between infection and immune response? Transpl Infect Dis. 2020;22:e13406.
29. Demir E, Uyar M, Parmaksiz E, Sinangil A, Yelken B, Dirim AB, Merhametsiz O, Yadigar S, Atan Ucar Z, Ucar AR, Demir ME, Mese M, Akin EB, Garayeva N, Safak S, Oto OA, Yazici H, Turkmen A. COVID-19 in kidney transplant recipients: A multicenter experience in Istanbul. Transpl Infect Dis. 2020;22:e13371.
30. Rodriguez-Cubillo B, de la Higuera MAM, Lucena R, Franci EV, Hurtado M, Romero NC, Moreno AR, Valencia D, Velo M, Fornie IS, Sanchez-Fructuoso AI. Should cyclosporine be useful in renal transplant recipients affected by SARS-CoV-2? Am J Transplant. 2020;20:3173-3181.
31. Murphy CC, Greiner K, Plskova J, Duncan L, Frost NA, Forrester JV, Dick AD. Cyclosporine vs tacrolimus therapy for posterior and intermediate uveitis. Arch Ophthalmol. 2005;123:634-641.
32. Carbajo-Lozoya J, Müller MA, Kallies S, Thiel V, Drosten C, von Brunn A. Replication of human coronaviruses SARS-CoV, HCoV-NL63 and HCoV229E is inhibited by the drug FK506. Virus Res. 2012; 165:112-117.
33. B Bossini N, Alberici F, Delbarba E, Valerio F, Manenti C, Possenti S, Econimo L, Maffei C, Pola A, Terlizzi V, Salviani C, Moscato M, Pasquali S, Zambetti N, Tonoli M, Affatato S, Pecchini P, Viola FB, Malberti F, Depetri G, Gaggiotti M, Scolari F; Brescia Renal COVID task force. Kidney transplant patients with SARS-CoV-2 infection: the brescia renal COVID task force experience. Am J Transplant. 2020;20:3019-3029.
34. Davatchi F, Sadeghi Abdollahi B, Shams H, Shahram F, Nadji A, ChamsDavatchi C, Faezi T, Akhlaghi M, Ghodsi Z, Ashofteh F, Mohtasham N. Combination of pulse cyclophosphamide and azathioprine in ocular manifestations of Behcet’s disease: longitudinal study of up to 10 years. Int J Rheum Dis. 2014;17:444-452.
35. Durrani K, Papaliodis GN, Foster CS. Pulse IV cyclophosphamide in ocular inflammatory disease: efficacy and short-term safety. Ophthalmology. 2004; 111:960-965.
36. Kanellopoulos A, Ahmed MZ, Kishore B, Lovell R, Horgan C, Paneesha S, Lloyd R, Salhan B, Giles H, Chauhan S, Venkatadasari I, Khakwani M, Murthy V, Xenou E, Dassanayake H, Srinath S, Kaparou M, Nikolousis E. COVID-19 in bone marrow transplant recipients: reflecting on a single centre experience. Br J Haematol. 2020;190:67-70.
37. Wendling D, Paccou J, Berthelot JM, Flipo RM, Guillaume-Czitrom S, Prati C, Dernis E, Direz G, Ferrazzi V, Ristori JM; CRI. New onset of uveitis during anti-tumor necrosis factor treatment for rheumatic diseases. Semin Arthritis Rheum. 2011;41:503-510.
38. Levy-Clarke G, Jabs DA, Read RW, Rosenbaum JT, Vitale A, Van Gelder RN. Expert panel recommendations for the use of anti-tumor necrosis factor biologic agents in patients with ocular inflammatory disorders. Ophthalmology. 2014;121:785-796.
39. Sharma SM, Ramanan AV, Riley P, Dick AD. Use of infliximab in juvenile onset rheumatological disease-associated refractory uveitis: efficacy in joint and ocular disease. Ann Rheum Dis. 2007;66:840-841.
40. Ally MR, Veerappan GR, Koff JM. Treatment of recurrent Crohn’s uveitis with infliximab. Am J Gastroenterol. 2008;103:2150-2151.
41. Matsuda J, Kaburaki T, Kobayashi S, Numaga J. Treatment of recurrent anterior uveitis with infliximab in patient with ankylosing spondylitis. Jpn J Ophthalmol. 2013;57:104-107.
42. Daudén E, Carretero G, Rivera R, Ferrándiz C, Llamas-Velasco M, de la Cueva P, Belinchón I, Gómez-García FJ, Herrera-Acosta E, Ruiz-Genao DP, Ferrán-Farrés M, Alsina M, Baniandrés-Rodríguez O, Sánchez-Carazo JL, Sahuquillo-Torralba A, Fernández-Freire LR, Vilar-Alejo J, García-Donoso C, Carrascosa JM, Herrera-Ceballos E, López-Estebaranz JL, Botella-Estrada R, Segovia-Muñoz E, Descalzo MA, García-Doval I; BIOBADADERM Study Group. Long-term safety of nine systemic medications for psoriasis: A cohort study using the Spanish Registry of Adverse Events for Biological Therapy in Dermatological Diseases (BIOBADADERM) Registry. J Am Acad Dermatol. 2020;83:139-150.
43. Lichtenstein GR, Feagan BG, Cohen RD, Salzberg BA, Safdi M, Popp JW, Jr., Langholff W, Sandborn WJ. Infliximab for Crohn’s Disease: More Than 13 Years of Real-world Experience. Inflamm Bowel Dis. 2018;24:490-501.
44. Queiro Silva R, Armesto S, González Vela C, Naharro Fernández C, GonzálezGay MA. COVID-19 patients with psoriasis and psoriatic arthritis on biologic immunosuppressant therapy vs apremilast in North Spain. Dermatol Ther. 2020;33:e13961.
45. Bezzio C, Manes G, Bini F, Pellegrini L, Saibeni S. Infliximab for severe ulcerative colitis and subsequent SARS-CoV-2 pneumonia: a stone for two birds. Gut. 2020;70:623-624.
46. Din S, Kent A, Pollok RC, Meade S, Kennedy NA, Arnott I, Beattie RM, Chua F, Cooney R, Dart RJ, Galloway J, Gaya DR, Ghosh S, Griffiths M, Hancock L, Hansen R, Hart A, Lamb CA, Lees CW, Limdi JK, Lindsay JO, Patel K, Powell N, Murray CD, Probert C, Raine T, Selinger C, Sebastian S, Smith PJ, Tozer P, Ustianowski A, Younge L, Samaan MA, Irving PM. Adaptations to the British Society of Gastroenterology guidelines on the management of acute severe UC in the context of the COVID-19 pandemic: a RAND appropriateness panel. Gut. 2020;69:1769-1777.
47. Dolinger MT, Person H, Smith R, Jarchin L, Pittman N, Dubinsky MC, Lai J. Pediatric Crohn Disease and Multisystem Inflammatory Syndrome in Children (MIS-C) and COVID-19 Treated With Infliximab. J Pediatr Gastroenterol Nutr. 2020;71:153-155.
48. Suhler EB, Lowder CY, Goldstein DA, Giles T, Lauer AK, Kurz PA, Pasadhika S, Lee ST, de Saint Sardos A, Butler NJ, Tessler HH, Smith JR, Rosenbaum JT. Adalimumab therapy for refractory uveitis: results of a multicentre, openlabel, prospective trial. Br J Ophthalmol. 2013;97:481-486.
49. Burmester GR, Panaccione R, Gordon KB, McIlraith MJ, Lacerda AP. Adalimumab: long-term safety in 23 458 patients from global clinical trials in rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis, psoriasis and Crohn’s disease. Ann Rheum Dis. 2013; 72:517-524.
50. Jaffe GJ, Dick AD, Brézin AP, Nguyen QD, Thorne JE, Kestelyn P, BarisaniAsenbauer T, Franco P, Heiligenhaus A, Scales D, Chu DS, Camez A, Kwatra NV, Song AP, Kron M, Tari S, Suhler EB. Adalimumab in Patients with Active Noninfectious Uveitis. N Engl J Med. 2016;375:932-943.
51. Valenti M, Facheris P, Pavia G, Gargiulo L, Borroni RG, Costanzo A, Narcisi A. Non-complicated evolution of COVID-19 infection in a patient with psoriasis and psoriatic arthritis during treatment with adalimumab. Dermatol Ther. 2020:e13708.
52. Tursi A, Angarano G, Monno L, Saracino A, Signorile F, Ricciardi A, Papa A. COVID-19 infection in Crohn’s disease under treatment with adalimumab. Gut. 2020;69:1364-1365.
53. Tosi GM, Sota J, Vitale A, Rigante D, Emmi G, Lopalco G, Guerriero S, Orlando I, Iannone F, Frediani B, Angotti R, Messina M, Galeazzi M, Vannozzi L, Cantarini L, Fabiani C. Efficacy and safety of certolizumab pegol and golimumab in the treatment of non-infectious uveitis. Clin Exp Rheumatol. 2019;37:680-683.
54. Blauvelt A, Paul C, van de Kerkhof P, Warren RB, Gottlieb AB, Langley RG, Brock F, Arendt C, Boehnlein M, Lebwohl M, Reich K. Long-Term Safety of Certolizumab Pegol in Plaque Psoriasis: Pooled Analysis over 3 Years from Three Phase 3, Randomised, Placebo-Controlled Studies. Br J Dermatol. 2020;184:640-651.
55. Sepah YJ, Sadiq MA, Chu DS, Dacey M, Gallemore R, Dayani P, Hanout M, Hassan M, Afridi R, Agarwal A, Halim MS, Do DV, Nguyen QD. Primary (Month-6) Outcomes of the STOP-Uveitis Study: Evaluating the Safety, Tolerability, and Efficacy of Tocilizumab in Patients With Noninfectious Uveitis. Am J Ophthalmol. 2017;183:71-80.
56. Jones G, Sebba A, Gu J, Lowenstein MB, Calvo A, Gomez-Reino JJ, Siri DA, Tomsic M, Alecock E, Woodworth T, Genovese MC. Comparison of tocilizumab monotherapy versus methotrexate monotherapy in patients with moderate to severe rheumatoid arthritis: the AMBITION study. Ann Rheum Dis. 2010;69:88-96.
57. Pawar A, Desai RJ, Solomon DH, Santiago Ortiz AJ, Gale S, Bao M, Sarsour K, Schneeweiss S, Kim SC. Risk of serious infections in tocilizumab versus other biologic drugs in patients with rheumatoid arthritis: a multidatabase cohort study. Ann Rheum Dis. 2019;78:456-464.
58. Mihai C, Dobrota R, Schröder M, Garaiman A, Jordan S, Becker MO, Maurer B, Distler O. COVID-19 in a patient with systemic sclerosis treated with tocilizumab for SSc-ILD. Ann Rheum Dis. 2020;79:668-669.
59. Pérez-Sáez MJ, Blasco M, Redondo-Pachón D, Ventura-Aguiar P, Bada-Bosch T, Pérez-Flores I, Melilli E, Sánchez-Cámara LA, López-Oliva MO, Canal C, Shabaka A, Garra-Moncau N, Martín-Moreno PL, López V, HernándezGallego R, Siverio O, Galeano C, Espí-Reig J, Cabezas CJ, Rodrigo MT, LlinàsMallol L, Fernández-Reyes MJ, Cruzado-Vega L, Pérez-Tamajón L, SantanaEstupiñán R, Ruiz-Fuentes MC, Tabernero G, Zárraga S, Ruiz JC, GutiérrezDalmau A, Mazuecos A, Sánchez-Álvarez E, Crespo M, Pascual J; Spanish Society of Nephrology COVID-19 Group. Use of tocilizumab in kidney transplant recipients with COVID-19. Am J Transplant. 2020;20:3182- 3190.
60. Dick AD, Tugal-Tutkun I, Foster S, Zierhut M, Melissa Liew SH, Bezlyak V, Androudi S. Secukinumab in the treatment of noninfectious uveitis: results of three randomized, controlled clinical trials. Ophthalmology. 2013;120:777- 787.
61. McInnes IB, Mease PJ, Ritchlin CT, Rahman P, Gottlieb AB, Kirkham B, Kajekar R, Delicha EM, Pricop L, Mpofu S. Secukinumab sustains improvement in signs and symptoms of psoriatic arthritis: 2 year results from the phase 3 FUTURE 2 study. Rheumatology (Oxford). 2017;56:1993-2003.
62. Carugno A, Gambini DM, Raponi F, Vezzoli P, Robustelli Test E, Arosio MEG, Callegaro A, Sena P. Coronavirus disease 2019 (COVID-19) rash in a psoriatic patient treated with Secukinumab: is there a role for Interleukin 17? Dermatol Ther. 2020;33:e14011.
63. Pacha O, Sallman MA, Evans SE. COVID-19: a case for inhibiting IL-17? Nat Rev Immunol. 2020;20:345-346.
64. Sharmeen S, Elghawy A, Zarlasht F, Yao Q. COVID-19 in rheumatic disease patients on immunosuppressive agents. Semin Arthritis Rheum. 2020;50:680-686.
65. Sanchez-Piedra C, Diaz-Torne C, Manero J, Pego-Reigosa JM, Rúa-Figueroa Í, Gonzalez-Gay MA, Gomez-Reino J, Alvaro-Gracia JM; BIOBADASER study group. Clinical features and outcomes of COVID-19 in patients with rheumatic diseases treated with biological and synthetic targeted therapies. Ann Rheum Dis. 2020;79:988-990.
66. Fabiani C, Vitale A, Rigante D, Emmi G, Lopalco G, Di Scala G, Sota J, Orlando I, Franceschini R, Frediani B, Galeazzi M, Iannone F, Tosi GM, Cantarini L. The Presence of Uveitis Is Associated with a Sustained Response to the Interleukin (IL)-1 Inhibitors Anakinra and Canakinumab in Behçet’s Disease. Ocul Immunol Inflamm. 2020;28:298-304.
67. Sota J, Vitale A, Insalaco A, Sfriso P, Lopalco G, Emmi G, Cattalini M, Manna R, Cimaz R, Priori R, Talarico R, de Marchi G, Frassi M, Gallizzi R, Soriano A, Alessio M, Cammelli D, Maggio MC, Gentileschi S, Marcolongo R, La Torre F, Fabiani C, Colafrancesco S, Ricci F, Galozzi P, Viapiana O, Verrecchia E, Pardeo M, Cerrito L, Cavallaro E, Olivieri AN, Paolazzi G, Vitiello G, Maier A, Silvestri E, Stagnaro C, Valesini G, Mosca M, de Vita S, Tincani A, Lapadula G, Frediani B, De Benedetti F, Iannone F, Punzi L, Salvarani C, Galeazzi M, Angotti R, Messina M, Tosi GM, Rigante D, Cantarini L; “Working Group” of Systemic Autoinflammatory Diseases of SIR (Italian Society of Rheumatology). Safety profile of the interleukin-1 inhibitors anakinra and canakinumab in real-life clinical practice: a nationwide multicenter retrospective observational study. Clin Rheumatol. 2018;37:2233-2240.
68. Monteagudo LA, Boothby A, Gertner E. Continuous Intravenous Anakinra Infusion to Calm the Cytokine Storm in Macrophage Activation Syndrome. ACR Open Rheumatol. 2020;2:276-282.
69. Calabrese LH, Calabrese C. Cytokine release syndrome and the prospects for immunotherapy with COVID-19. Part 2: The role of interleukin 1. Cleve Clin J Med. 2020.
70. Lee JH, Lee CS, Lee SC. Interferon alpha-2a treatment for refractory Behcet uveitis in Korean patients. BMC Ophthalmol. 2018;18:52.
71. Yalçindag N, Köse HC. Comparison of the Treatment Results for Behçet Uveitis in Patients Treated with Infliximab and Interferon. Ocul Immunol Inflamm. 2020;28:305-314.
72. Yalçindag N, Yanık Ö, Düzgün N. Efficacy of Infliximab in Patients with Refractory Uveitis Associated with Behcet Disease. J Clin Exp Ophthalmol. 2014;1:1-5.
73. Deuter C, Stübiger N, Zierhut M. Interferon-α therapy in noninfectious uveitis. Dev Ophthalmol. 2012;51:90-97.
74. He G, Sun W, Wu J, Cai J. Serial Computed Tomography Findings in a Child with Coronavirus Disease (COVID-19) Pneumonia. Indian Pediatr. 2020;57:467-468.
75. Chen Q, Quan B, Li X, Gao G, Zheng W, Zhang J, Zhang Z, Liu C, Li L, Wang C, Zhang G, Li J, Dai Y, Yang J, Han W. A report of clinical diagnosis and treatment of nine cases of coronavirus disease 2019. J Med Virol. 2020;92:683-687.
76. Miserocchi E, Modorati G, Berchicci L, Pontikaki I, Meroni P, Gerloni V. Long-term treatment with rituximab in severe juvenile idiopathic arthritisassociated uveitis. Br J Ophthalmol. 2016; 100:782-786.
77. Lasave AF, You C, Ma L, Abusamra K, Lamba N, Valdes Navarro M, Meese H, Foster CS. Long-term outcomes of rıtuxımab therapy ın patıents wıth nonınfectıous posterıor uveıtıs refractory to conventıonal ımmunosuppressıve therapy. Retina. 2018;38:395-402.
78. Davatchi F, Shams H, Rezaipoor M, Sadeghi-Abdollahi B, Shahram F, Nadji A, Chams-Davatchi C, Akhlaghi M, Faezi T, Naderi N. Rituximab in intractable ocular lesions of Behcet’s disease; randomized single-blind control study (pilot study). Int J Rheum Dis. 2010;13:246-252.
79. Lerman MA, Rabinovich CE. The Future Is Now: Biologics for NonInfectious Pediatric Anterior Uveitis. Paediatr Drugs. 2015;17:283-301.
80. Luna G, Alping P, Burman J, Fink K, Fogdell-Hahn A, Gunnarsson M, Hillert J, Langer-Gould A, Lycke J, Nilsson P, Salzer J, Svenningsson A, Vrethem M, Olsson T, Piehl F, Frisell T. Infection Risks Among Patients With Multiple Sclerosis Treated With Fingolimod, Natalizumab, Rituximab, and Injectable Therapies. JAMA Neurol. 2019;77:184-191.
81. Nuño L, Novella Navarro M, Bonilla G, Franco-Gómez K, Aguado P, Peiteado D, Monjo I, Tornero C, Villalba A, Miranda-Carus ME, De Miguel E, Bogas P, Castilla-Plaza A, Bernad-Pineda M, García-Lorenzo E, Rodríguez-Araya T, Balsa A. Clinical course, severity and mortality in a cohort of patients with COVID-19 with rheumatic diseases. Ann Rheum Dis. 2020;79:1659-1661.
82. Schulze-Koops H, Krueger K, Vallbracht I, Hasseli R, Skapenko A. Increased risk for severe COVID-19 in patients with inflammatory rheumatic diseases treated with rituximab. Ann Rheum Dis. 2020;2021:218075.
83. Houot R, Levy R, Cartron G, Armand P. Could anti-CD20 therapy jeopardise the efficacy of a SARS-CoV-2 vaccine? Eur J Cancer. 2020; 136:4-6.
84. Maarouf A, Rico A, Boutiere C, Perriguey M, Demortiere S, Pelletier J, Audoin B; Under the aegis of OFSEP. Extending rituximab dosing intervals in patients with MS during the COVID-19 pandemic and beyond? Neurol Neuroimmunol Neuroinflamm. 2020;7:825.
85. Birolo C, Zannin ME, Arsenyeva S, Cimaz R, Miserocchi E, Dubko M, Deslandre CJ, Falcini F, Alessio M, La Torre F, Denisova E, Martini G, Nikishina I, Zulian F. Comparable Efficacy of Abatacept Used as First-line or Second-line Biological Agent for Severe Juvenile Idiopathic Arthritis-related Uveitis. J Rheumatol. 2016;43:2068-2073.
86. Alten R, Kaine J, Keystone E, Nash P, Delaet I, Genovese MC. Long-term safety of subcutaneous abatacept in rheumatoid arthritis: integrated analysis of clinical trial data representing more than four years of treatment. Arthritis Rheumatol. 2014;66:1987-1997.
87. Steingo B, Al Malik Y, Bass AD, Berkovich R, Carraro M, Fernández Ó, Ionete C, Massacesi L, Meuth SG, Mitsikostas DD, Pardo G, Simm RF, Traboulsee A, Choudhry Z, Daizadeh N, Compston DAS; CAMMS223, CAMMS03409, and TOPAZ Investigators. J Neurol. 2020;267:3343-3353.
88. Isaacs JD, Hale G, Waldmann H, Dick AD, Haynes R, Forrester JV, Watson P, Meyer PA. Monoclonal antibody therapy of chronic intraocular inflammation using Campath-1H. Br J Ophthalmol. 1995;79:1054-1055.
89. Dalla Costa G, Leocani L, Montalban X, Guerrero AI, Sørensen PS, Magyari M, Dobson RJB, Cummins N, Narayan VA, Hotopf M, Comi G; RADARCNS consortium. Real-time assessment of COVID-19 prevalence among multiple sclerosis patients: a multicenter European study. Neurol Sci. 2020;41:1647-1650.
90. Lu CW, Liu XF, Jia ZF. 2019-nCoV transmission through the ocular surface must not be ignored. Lancet. 2020;395:e39.
91. Choudhary R, Kapoor MS, Singh A, Bodakhe SH. Therapeutic targets of renin-angiotensin system in ocular disorders. J Curr Ophthalmol. 2017;29:7- 16.
92. Ma D, Chen CB, Jhanji V, Xu C, Yuan XL, Liang JJ, Huang Y, Cen LP, Ng TK. Expression of SARS-CoV-2 receptor ACE2 and TMPRSS2 in human primary conjunctival and pterygium cell lines and in mouse cornea. Eye (Lond). 2020;34:1212-1219.
93. Seah I, Agrawal R. Can the Coronavirus Disease 2019 (COVID-19) Affect the Eyes? A Review of Coronaviruses and Ocular Implications in Humans and Animals. Ocul Immunol Inflamm. 2020;28:391-395.
94. Xia J, Tong J, Liu M, Shen Y, Guo D. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol. 2020;92:589-594.
95. Wu P, Duan F, Luo C, Liu Q, Qu X, Liang L, Wu K. Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol. 2020; 138:575-578.
96. Bostanci Ceran B, Ozates S. Ocular manifestations of coronavirus disease 2019. Graefes Arch Clin Exp Ophthalmol. 2020;258:1959-1963.
97. Casagrande M, Fitzek A, Püschel K, Aleshcheva G, Schultheiss HP, Berneking L, Spitzer MS, Schultheiss M. Detection of SARS-CoV-2 in Human Retinal Biopsies of Deceased COVID-19 Patients. Ocul Immunol Inflamm. 2020;28:721-725.
98. Marinho PM, Marcos AAA, Romano AC, Nascimento H, Belfort R, Jr. Retinal findings in patients with COVID-19. Lancet. 2020; 395:1610.
99. Vavvas DG, Sarraf D, Sadda SR, Eliott D, Ehlers JP, Waheed NK, Morizane Y, Sakamoto T, Tsilimbaris M, Miller JB. Concerns about the interpretation of OCT and fundus findings in COVID-19 patients in recent Lancet publication. Eye (Lond). 2020;34:2153-2154.
100.Bettach E, Zadok D, Weill Y, Brosh K, Hanhart J. Bilateral anterior uveitis as a part of a multisystem inflammatory syndrome secondary to COVID-19 infection. J Med Virol. 2021;93:139-140.
101.Dick AD, Rosenbaum JT, Al-Dhibi HA, Belfort R Jr, Brézin AP, Chee SP, Davis JL, Ramanan AV, Sonoda KH, Carreño E, Nascimento H, Salah S, Salek S, Siak J, Steeples L; Fundamentals of Care for Uveitis International Consensus Group. Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis: Fundamentals Of Care for UveitiS (FOCUS) Initiative. Ophthalmology. 2018; 125:757-773.
102.Zierhut M, De Smet MD, Gupta V, Pavesio C, Nguyen QD, Chee SP, Cunningham ET, Agrawal R. Evolving Consensus Experience of the IUSGIOIS-FOIS with Uveitis in the Time of COVID-19 Infection. Ocul Immunol Inflamm. 2020; 28:709-713.
103.Gupta V, Rajendran A, Narayanan R, Chawla S, Kumar A, Palanivelu MS, Muralidhar NS, Jayadev C, Pappuru R, Khatri M, Agarwal M, Aurora A, Bhende P, Bhende M, Bawankule P, Rishi P, Vinekar A, Trehan HS, Biswas J, Agarwal R, Natarajan S, Verma L, Ramasamy K, Giridhar A, Rishi E, Talwar D, Pathangey A, Azad R, Honavar SG. Indian J Ophthalmol. 2020;68:962- 973.
104.Smith JR, Lai TYY. Managing Uveitis during the COVID-19 Pandemic. Ophthalmology. 2020;127:65-67.
105.Hung JCH, Li KKW. Implications of COVID-19 for uveitis patients: perspectives from Hong Kong. Eye (Lond). 2020;34:1163-1164.
106.Thng ZX, De Smet MD, Lee CS, Gupta V, Smith JR, McCluskey PJ, Thorne JE, Kempen JH, Zierhut M, Nguyen QD, Pavesio C, Agrawal R. COVID19 and immunosuppression: a review of current clinical experiences and implications for ophthalmology patients taking immunosuppressive drugs. Br J Ophthalmol. 2020;105:306-310.
107.Stanescu-Segall D, Sales de Gauzy T, Reynolds R, Faes L, Pohlmann D, Pakzad-Vaezi K, Ting D, Saadoun D, Ambati J, Loewenstein A, Bodaghi B, de Smet MD, Touhami S. Expert opinion on the management and follow-up of uveitis patients during SARS-CoV-2 outbreak. Expert Rev Clin Immunol. 2020;16:651-657.
108.Agrawal R, Testi I, Lee CS, Tsui E, Blazes M, Thorne JE, Okada AA, Smith JR, McCluskey PJ, Kempen JH, Tappeiner C, Agarwal M, Bodaghi B, Nguyen QD, Gupta V, De Smet MD, Zierhut M, Pavesio C; COVID-19 IMT Study Group. Evolving consensus for immunomodulatory therapy in non-infectious uveitis during the COVID-19 pandemic. Br J Ophthalmol. 2020;105:639-647.
109.Landewé RB, Machado PM, Kroon F, Bijlsma HW, Burmester GR, Carmona L, Combe B, Galli M, Gossec L, Iagnocco A, Isaacs JD, Mariette X, McInnes I, Mueller-Ladner U, Openshaw P, Smolen JS, Stamm TA, Wiek D, SchulzeKoops H. EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2. Ann Rheum Dis. 2020;79:851-858.
110.Espinosa G, Araujo O, Amaro S, Bodro M, Moreno PJ, Moreno R, Ugarte A, Cervera R. COVID-19 and Behçet’s disease: clinical case series. Ann Rheum Dis. 2020;2020:217778.
111.Yurttaş B, Oztas M, Tunc A, Balkan İİ, Tabak OF, Hamuryudan V, Seyahi E. Characteristics and outcomes of Behçet’s syndrome patients with Coronavirus Disease 2019: a case series of 10 patients. Intern Emerg Med. 2020;15:1567- 1571.

APA	Değirmenci M, YALÇINDAĞ F, Tugal-Tutkun I (2021). Oftalmolojide İmmünomodülatör Ajanların Kullanımı ve COVID-19. , 231 - 242. 10.4274/tjo.galenos.2021.68252
Chicago	Değirmenci Mehmet Fatih Kağan,YALÇINDAĞ FATİME NİLÜFER,Tugal-Tutkun Ilknur Oftalmolojide İmmünomodülatör Ajanların Kullanımı ve COVID-19. (2021): 231 - 242. 10.4274/tjo.galenos.2021.68252
MLA	Değirmenci Mehmet Fatih Kağan,YALÇINDAĞ FATİME NİLÜFER,Tugal-Tutkun Ilknur Oftalmolojide İmmünomodülatör Ajanların Kullanımı ve COVID-19. , 2021, ss.231 - 242. 10.4274/tjo.galenos.2021.68252
AMA	Değirmenci M,YALÇINDAĞ F,Tugal-Tutkun I Oftalmolojide İmmünomodülatör Ajanların Kullanımı ve COVID-19. . 2021; 231 - 242. 10.4274/tjo.galenos.2021.68252
Vancouver	Değirmenci M,YALÇINDAĞ F,Tugal-Tutkun I Oftalmolojide İmmünomodülatör Ajanların Kullanımı ve COVID-19. . 2021; 231 - 242. 10.4274/tjo.galenos.2021.68252
IEEE	Değirmenci M,YALÇINDAĞ F,Tugal-Tutkun I "Oftalmolojide İmmünomodülatör Ajanların Kullanımı ve COVID-19." , ss.231 - 242, 2021. 10.4274/tjo.galenos.2021.68252
ISNAD	Değirmenci, Mehmet Fatih Kağan vd. "Oftalmolojide İmmünomodülatör Ajanların Kullanımı ve COVID-19". (2021), 231-242. https://doi.org/10.4274/tjo.galenos.2021.68252

APA	Değirmenci M, YALÇINDAĞ F, Tugal-Tutkun I (2021). Oftalmolojide İmmünomodülatör Ajanların Kullanımı ve COVID-19. Türk Oftalmoloji Dergisi, 51(4), 231 - 242. 10.4274/tjo.galenos.2021.68252
Chicago	Değirmenci Mehmet Fatih Kağan,YALÇINDAĞ FATİME NİLÜFER,Tugal-Tutkun Ilknur Oftalmolojide İmmünomodülatör Ajanların Kullanımı ve COVID-19. Türk Oftalmoloji Dergisi 51, no.4 (2021): 231 - 242. 10.4274/tjo.galenos.2021.68252
MLA	Değirmenci Mehmet Fatih Kağan,YALÇINDAĞ FATİME NİLÜFER,Tugal-Tutkun Ilknur Oftalmolojide İmmünomodülatör Ajanların Kullanımı ve COVID-19. Türk Oftalmoloji Dergisi, vol.51, no.4, 2021, ss.231 - 242. 10.4274/tjo.galenos.2021.68252
AMA	Değirmenci M,YALÇINDAĞ F,Tugal-Tutkun I Oftalmolojide İmmünomodülatör Ajanların Kullanımı ve COVID-19. Türk Oftalmoloji Dergisi. 2021; 51(4): 231 - 242. 10.4274/tjo.galenos.2021.68252
Vancouver	Değirmenci M,YALÇINDAĞ F,Tugal-Tutkun I Oftalmolojide İmmünomodülatör Ajanların Kullanımı ve COVID-19. Türk Oftalmoloji Dergisi. 2021; 51(4): 231 - 242. 10.4274/tjo.galenos.2021.68252
IEEE	Değirmenci M,YALÇINDAĞ F,Tugal-Tutkun I "Oftalmolojide İmmünomodülatör Ajanların Kullanımı ve COVID-19." Türk Oftalmoloji Dergisi, 51, ss.231 - 242, 2021. 10.4274/tjo.galenos.2021.68252
ISNAD	Değirmenci, Mehmet Fatih Kağan vd. "Oftalmolojide İmmünomodülatör Ajanların Kullanımı ve COVID-19". Türk Oftalmoloji Dergisi 51/4 (2021), 231-242. https://doi.org/10.4274/tjo.galenos.2021.68252