• Written By: Ralph Levinson, MD

    This retrospective analysis included the records of 59 patients with recurrent nongranulomatous, idiopathic, or HLA-B27-associated acute anterior uveitis (AAU) treated with nonsteroidal anti-inflammatory drugs (NSAIDs), either celecoxib (Celebrex) or diflunisal (Dolobid), for an average of 21.2 months. All patients were followed-up for at least one year before and after starting NSAID therapy.

    The recurrence rate for all patients was 2.84 per person-year follow-up before NSAID therapy and 0.53 per person-year follow-up after therapy (P < 0.001). The relapse rate was similar for both NSAIDs, but patients on clecoxib remained in remission longer (21 months) than patients on diflunisal (15.34 months). Ten patients developed side effects in the diflunisal group, with five having to discontinue treatment, while only one of 30 subjects on clecoxib experienced a side effect (gastrointestinal), which resolved after the dosage was decreased. The during-treatment relapse rate in the HLA-B27-positive group was significantly less (0.24) than that of the HLA-B27-negative group (0.66; P < 0.001).

    When considering whether to initiate such therapy one must consider the potential risks of the medication against the potential benefits. Many patients with AAU do quite well, with modest episodes that are controlled by topical therapy, although some have frequent recurrences with sight threatening sequelae (which can result from even a single severe episode). Others have disease that will vary quite a bit from year to year, and it has been shown that over time the rate of recurrences tends to decrease (a concern, along with the phenomenon of regression to the mean, when evaluating retrospective, sequential studies).

    In addition Celebrex has two FDA mandated "black box" warnings (fatal gastrointestinal and cardiovascular complications), and in the current study side effects with Dolobid were common. Nonetheless there are patients who would benefit considerably if the rate of recurrences of AAU were decreased.