Background Clinical trials suggested that bisphosphonates (BP) were safe and well tolerated drugs, but post-marketing studies have shown their association with rare adverse events but potentially serious, including inflammatory ocular disorders, especially scleritis and uveitis. These disorders deserve to be taken into account due to their significant risk of visual loss.
Objectives To describe the demographic, clinical and outcome characteristics of patients diagnosed with uveitis during treatment with BF.
Methods We conducted a retrospective study (2003-2012) in an university hospital with an assigned area of 600,000 inhabitants. We reviewed all cases of uveitis occurring in patients treated with BF, excluding those with a history of uveitis before the start of BP treatment.
Results There were 18 cases of uveitis during treatment with BF, all being women with a mean age at diagnosis of 64.9 ± 11.3 years (38-82). 61% were treated with alendronate and 39% with risedronate. 5 cases (27%) had a history of autoimmune disease, but no episodes of ocular inflammation before the start of BF, and these diagnosis were inflammatory bowel disease with or without associated spondyloarthritis (3), adult-onset Still’s disease (1) and primary biliary cirrhosis (1). The time since the start of BF until uveitis onset was 30.4 ± 18 months (8-63). All patients developed uni (89%) or bilateral (11%) acute anterior uveitis, being the most common clinical presentation the combination of pain and redness (56%). In 2 of them (11%) other ocular inflammatory conditions occurred simultaneously (superficial punctate keratitis [SPK] and follicular conjunctivitis, respectively) and 10 cases (56%) developed ocular complications (cataract 22%, 16% synechiae, vitreous detachment 16%, and macular edema 5%). Retrospectively it was observed that 3 patients had episodes of ocular inflammation during treatment with BF before development of uveitis, corresponding to scleritis, episcleritis, and blepharitis + SPK, respectively. All cases were treated with topical corticosteroids and cycloplegic, suspending the BF for this event in only 1 case (6%), due to other causes in 2 (11%) and continuing in the remaining (83%). After the first episode of uveitis was remission in 72%, and 28% had a recurrent course; however up to 44% developed other inflammatory events during follow-up.
Conclusions There are several published case series describing the association of BF and uveitis. However, only 2 large epidemiologic studies have been carried out, and one of them had statistical power to demonstrate this association, being the estimated prevalence 29/10,000 patient-years. Uveitis occurs most often with aminobisphosphonates and unlike other adverse events associated with prolonged use, may appear much earlier, since days to months. Most of our patients had no underlying conditions to justify the development of uveitis and in all of them it appeared after BF administration, with other associated ocular inflammatory conditions ocurring before and after this event, reinforcing their possible association. A very important aspect to consider is the morbidity caused by these disorders, developing sequels in over half the cases, so it is important consider the BF use in the evaluation of patients with uveitis, as it has been observed that withdrawn of these agents may reverse uveitis and reintroduction exacerbate it.
Disclosure of Interest None Declared
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