[Treatment of uveitis with immunosuppressives: antimetabolites and alkylating agents].

Oral corticosteroids remain the main therapeutical choice in patients with uveitis not responding to topical treatment, however their chronic use can be very toxic, especially for bones (osteoporosis or growth retardation). Immunosuppresive agents are used as corticosteroid sparing agents and/or as agents able to control refractory uveitis in sight threatening uveitis. Cyclosporin A is very efficacious but is nephrotoxic, in particular in old people. Methotrexate is well tolerated in young people, is not carcinogenic but not very active. Azathioprine is well tolerated but it's carcinogenic effect and its delayed action are helpful in chronic uveitis of old women. Cyclophosphamide and intravenous steroids are helpful for emergencies. Chlorambucil is toxic and carcinogenic but might lead to an increased rate of remission and might be useful as a short treatment. In any case, a careful and regular follow-up in collaboration with a competent internist is mandatory.