8 results on '"Laar, Jan A. M."'
Search Results
2. Long-Term Follow-up of Patients With Uveitis Treated With Adalimumab: Response Rates and Reasons for Discontinuation of Therapy.
- Author
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Eurelings LEM, Missotten TOAR, van Velthoven MEJ, van Daele PLA, van Laar JAM, van Hagen PM, Thiadens AAHJ, and Rombach SM
- Subjects
- Adalimumab adverse effects, Cohort Studies, Follow-Up Studies, Humans, Neoplasm Recurrence, Local, Retrospective Studies, Treatment Outcome, Drug-Related Side Effects and Adverse Reactions, Uveitis chemically induced, Uveitis diagnosis, Uveitis drug therapy
- Abstract
Purpose: To evaluate the effectiveness and reasons for discontinuation including the side effect profiles of adalimumab in a real-world setting., Design: Retrospective clinical cohort study., Methods: A medical chart review of clinical practice in 2 tertiary eye care services in Rotterdam, the Netherlands, was performed Data were collected from May 1, 2004, through September 1, 2020. Patients with noninfectious uveitis treated with adalimumab (n = 341; 633 affected eyes) were included. The primary outcome was the effectiveness of adalimumab, measured by the number of patients achieving inactive disease, remission, and relapse-free survival. The secondary outcomes were the reasons for discontinuation, including side effects, and the number of patients who developed antibodies., Results: In total, 341 patients were treated with adalimumab between May 2004 and September 2020. The uveitis recurrence-free survival interval was 3.4 years (range, 0-13 years). Adalimumab had an acceptable side effect profile. A total of 178 patients achieved inactive disease while continuing adalimumab, and 51 patients maintained remission after discontinuing adalimumab. Reasons for discontinuation of adalimumab were no response, relapse, or reasons unrelated to the effectiveness of treatment. Adalimumab antibodies were present in 40 of 115 patients (35%). Antibodies were associated with lower adalimumab levels, and antibodies were observed more often in patients on adalimumab monotherapy (P < .01)., Conclusions: Adalimumab is effective for patients with noninfectious uveitis, with an acceptable side effect profile. Although relapses can occur, the majority of the patients achieved inactive disease or remission after cessation of adalimumab, without other systemic immunosuppressive medication., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
3. Prevalence of Positive QuantiFERON-TB Gold In-Tube Test in Uveitis and its Clinical Implications in a Country Nonendemic for Tuberculosis.
- Author
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Groen-Hakan F, van Laar JAM, Bakker M, van Hagen PM, Hardjosantoso H, and Rothova A
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- Adult, Aged, Antitubercular Agents therapeutic use, Cross-Sectional Studies, False Positive Reactions, Female, Humans, Male, Middle Aged, Mycobacterium tuberculosis isolation & purification, Netherlands, Prevalence, Retrospective Studies, Tuberculin Test methods, Tuberculosis, Ocular microbiology, Uveitis microbiology, Interferon-gamma Release Tests methods, Tuberculosis, Ocular diagnosis, Uveitis diagnosis
- Abstract
Purpose: To report on the prevalence and clinical implications of positive QuantiFERON-Gold (QFT-G) test results in the diagnostic evaluation of a large cohort of consecutive patients with uveitis in the Netherlands., Design: Retrospective cross-sectional study., Methods: This study included 710 consecutive patients who all underwent evaluation for uveitis including QFT-G testing. The ocular features, comorbidity, and abnormalities in diagnostic imaging and laboratory tests were registered for QFT-G-positive patients with uveitis., Results: Of all patients, 13% (92/710) were positive for QFT-G. Previously treated tuberculosis (TB) was documented in 2 patients. Of all 92 QFT-G-positive patients, culture-proven active TB was observed in 1 case. The proportion of patients with uveitis of unknown etiology was higher in QFT-G-positive than in the QFT-G-negative patients (54/92, 59% vs 238/618, 39%; P = .0004). The uveitis features of QFT-G-positive patients were mainly nonspecific. Of all QFT-G-positive patients with uveitis, 17 patients had chest imaging changes suggesting either TB or sarcoidosis. Twenty-nine QFT-G-positive patients with otherwise unexplained uveitis completed antituberculous therapy (29/710; 4% of all included patients) with beneficial effect in most cases., Conclusion: The QFT-G tested positive in 13% of patients with uveitis in the Netherlands, whereas only sporadic patients had a documented previous or active TB infection. The proportion of patients with unexplained uveitis was higher in QFT-G-positive patients. Though the association between uveitis and a positive QFT-G test might be coincidental, the majority of treated QFT-G-positive patients with otherwise unexplained severe uveitis cause had a beneficial response to antituberculous therapy., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
4. Chest Radiographic Screening for Sarcoidosis in the Diagnosis of Patients with Active Uveitis.
- Author
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Groen F, van Laar JAM, and Rothova A
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- Adult, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Netherlands epidemiology, Radiography, Thoracic, Retrospective Studies, Sarcoidosis pathology, Sensitivity and Specificity, Tertiary Care Centers, Lung diagnostic imaging, Sarcoidosis diagnostic imaging, Sarcoidosis epidemiology, Uveitis complications
- Abstract
Rationale: Although chest radiography is currently recommended for the initial evaluation of patients with new-onset uveitis, the efficacy of this diagnostic screening modality is not known., Objectives: To evaluate the diagnostic value of chest radiographs in patients with active uveitis of recent onset in a tertiary center in Western Europe., Methods: A retrospective cross-sectional study was conducted by reviewing all chest imaging for adults with new-onset (<1 yr) uveitis of unknown origin undergoing initial evaluation in the Department of Ophthalmology at Erasmus University Medical Center (Rotterdam, the Netherlands). Radiographic findings were related to clinical and other imaging characteristics and to final diagnoses., Results: Screening chest radiographs were abnormal for 30 of 200 patients (15%) included in this study. Twenty-two of the 200 patients (11%) had biopsy-confirmed sarcoidosis, and an additional 12 patients were presumed to have sarcoidosis. The finding of chest radiographic abnormalities interpreted as typical of sarcoidosis was specific (91%; 95% confidence interval, 85.9-94.4%) but not sensitive (64%; 95% confidence interval, 43.0-80.3%) for biopsy-confirmed sarcoidosis. The combination of elevated serum angiotensin-converting enzyme level and chest radiographic findings typical of sarcoidosis increased the sensitivity to 79%. Biopsy-confirmed sarcoidosis was more common in patients with panuveitis (17 of 84; 20%) compared to patients with other anatomical locations of uveitis (5 of 116, 4%; P < 0.001). One patient was diagnosed with active pulmonary and ocular tuberculosis., Conclusions: Abnormal chest radiographs were found in 15% of patients with active uveitis of unknown origin and onset within 1 year of referral to a tertiary center in the Netherlands. A majority of the abnormal chest radiographs showed findings compatible with a diagnosis of sarcoidosis.
- Published
- 2017
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5. [Diagnosis and treatment of uveitis; not restricted to the ophthalmologist].
- Author
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van Laar JA, van Velthoven ME, Missotten T, Kuijpers R, van Hagen PM, and Rothova A
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- Anti-Bacterial Agents therapeutic use, Chronic Disease, Humans, Immunologic Factors therapeutic use, Referral and Consultation, Uveitis drug therapy, Uveitis etiology, Uveitis diagnosis
- Abstract
Visual symptoms due to uveitis involve a wide range of possible causes. Familiarity with its clinical manifestations, referral indications and treatment strategies is required for the optimal use of current therapeutic options. Uveitis can be caused by infectious and non-infectious factors, resulting in differing prognoses and treatments. The treatment of chronic, non-infectious uveitis has profoundly changed in the last years due to the advent of biological therapies. In severe uveitis, treatment of the underlying cause is required for the prevention of the loss of vision; multidisciplinary team collaboration is therefore important.
- Published
- 2013
6. Octreotide long-acting repeatable for the treatment of chronic macular edema in uveitis.
- Author
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Missotten T, van Laar JA, van der Loos TL, van Daele PL, Kuijpers RW, Baarsma GS, and van Hagen PM
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- Chronic Disease, Female, Fluorescein Angiography, Humans, Injections, Intramuscular, Macular Edema diagnosis, Macular Edema etiology, Male, Middle Aged, Octreotide administration & dosage, Recurrence, Retrospective Studies, Time Factors, Tomography, Optical Coherence, Visual Acuity, Macular Edema drug therapy, Octreotide therapeutic use, Uveitis complications
- Abstract
Purpose: To report on the efficacy of the somatostatin analog octreotide long-acting repeatable (LAR), in the treatment of uveitic chronic macular edema (CME)., Design: Case series, retrospective analysis., Methods: In 20 patients, 20 episodes of recurrent CME during otherwise quiescent uveitis were treated with intramuscular octreotide LAR injections. Patients were included if CME control with acetazolamide or systemic and periocular steroids had failed during previous CME episodes or if contraindications existed for persistent use of these therapies. Mean outcome points were CME and visual acuity changes. Correlation of prognostic factors with these outcomes was analyzed., Results: The included CME episodes occurred 7.6 +/- 1.4 years after onset of uveitis. Octreotide LAR treatment started 7.0 +/- 7.3 months after diagnosis of CME. CME decreased in 70% of episodes, after 2.7 +/- 1.3 months of treatment. After arrest of successful treatment, CME recurred instantly (27.2%) or within six months (36.4%). In 36.4% of successfully treated episodes, CME was absent for more than one year. A probable prognostic factor for success was the duration of CME before treatment., Conclusions: Octreotide LAR had an edema-reducing effect in 70% of treated CME episodes. Successful response was related to duration of CME before start of treatment. The early recurrence of CME (63.6%) after arrest of octreotide LAR advocates a long-term treatment in recent episodes of macular edema in otherwise quiescent uveitis.
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- 2007
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7. Diagnosis and treatment of uveitis; not restricted to the ophthalmologist
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van Laar, Jan A M, Rothova, Aniki, Missotten, Tom, Kuijpers, Robert W A M, van Hagen, P Martin, van Velthoven, Mirjam E J, and Surgical clinical sciences
- Subjects
Medicine(all) ,ethiology ,uveitis ,immunosuppressive therapy ,multidisciplinary management ,Review ,anti-TNF - Abstract
Uveitis is associated with a wide range of underlying causes. Familiarity with its clinical manifestations, referral indications, and treatment strategies are required for the optimal use of current therapeutic options. Uveitis can be caused by infectious and non-infectious factors, resulting in differing prognoses and treatments. The treatment of chronic, non-infectious uveitis has profoundly changed in the last years due to the advent of biologicals, but also of intraocular therapies. In severe uveitis, treatment of the underlying cause, whether ocular or systemic, is required to prevent severe loss of vision. For these purposes, a multidisciplinary clinical approach is important, which is addressed in this review. Relevance for patients: A broad understanding of the different causes of uveitis and the implementation of disease-tailored, multidisciplinary management of uveitis is expected to improve treatment outcomes for patients with different types of uveitis.
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- 2015
8. Diagnose en behandeling van uveїtis; niet beperkt tot de oogarts
- Author
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van Laar, Jan A M, van Velthoven, Mirjam E J, Missotten, Tom, Kuijpers, Robert W A M, van Hagen, P Martin, Rothova, Aniki, and Snijdende Klinische wetenschappen
- Subjects
Uveitis ,Treatment ,Medicine(all) ,Anti-Bacterial Agents/therapeutic use ,therapy ,diagnosis ,Uveitis/diagnosis ,Humans ,chronic disease ,Immunologic Factors/therapeutic use ,Referral and Consultation - Abstract
Visual symptoms due to uveitis involve a wide range of possible causes. Familiarity with its clinical manifestations, referral indications and treatment strategies is required for the optimal use of current therapeutic options. Uveitis can be caused by infectious and non-infectious factors, resulting in differing prognoses and treatments. The treatment of chronic, non-infectious uveitis has profoundly changed in the last years due to the advent of biological therapies. In severe uveitis, treatment of the underlying cause is required for the prevention of the loss of vision; multidisciplinary team collaboration is therefore important.
- Published
- 2013
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