Corticosteroids as adjuvant therapy for ocular toxoplasmosis.

Smitha Jasper, Satyanarayana S. Vedula, Sheeja S. John, Saban Horo, Yasir J. Sepah, Quan Dong Nguyen

Research output: Contribution to journalArticle

Abstract

Ocular infestation with Toxoplasma gondii, a parasite, may result in inflammation in the retina, choroid, and uvea and consequently lead to complications such as glaucoma, cataract, and posterior synechiae. The objective of this systematic review was to assess the effects of adjunctive use of corticosteroids for ocular toxoplasmosis. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 9), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to October 2012), EMBASE (January 1980 to October 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to October 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We searched the reference lists of included studies for any additional studies not identified by the electronic searches. We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 11 October 2012. We planned to include randomized and quasi-randomized controlled trials. Eligible trials would have enrolled participants of any age who were immunocompetent and were diagnosed with active ocular toxoplasmosis. Included trials would have compared anti-parasitic therapy plus corticosteroids versus anti-parasitic therapy alone, or different doses or times of initiation of corticosteroids. Two authors independently screened titles and abstracts retrieved from the electronic searches. We retrieved full-text articles of studies categorized as 'unsure' or 'include' after review of the abstracts. Two authors independently reviewed each full-text article. Discrepancies were resolved through discussion. The electronic searches retrieved 368 titles and abstracts. We reviewed 20 full-text articles. We identified no trials eligible for inclusion in this systematic review. Although research has identified wide variation in practices regarding use of corticosteroids, our systematic review did not identify evidence from randomized controlled trials for the role of corticosteroids in the management of ocular toxoplasmosis. Several questions remain unanswered by well-conducted randomized trials in this context, including whether use of corticosteroids is more effective than use of anti-parasitic therapy alone, when corticosteroids should be initiated in the treatment regimen (early versus late course of treatment), and which dosage and duration of steroid use is best. These questions are easily amenable to research using a randomized controlled design and they are ethical due to the absence of evidence to support or discourage use of corticosteroids for this condition. The question of foremost importance, however, is whether they should be used as adjunct therapy (that is, additional) to anti-parasitic agents.

Original languageEnglish (US)
JournalThe Cochrane database of systematic reviews
Volume4
StatePublished - 2013
Externally publishedYes

Fingerprint

Ocular Toxoplasmosis
Adrenal Cortex Hormones
MEDLINE
Therapeutics
Randomized Controlled Trials
Uvea
Choroid
Toxoplasma
Research
Glaucoma
Cataract
Libraries
Registries
Retina
Parasites
Language
Steroids
Clinical Trials
Databases
Inflammation

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Jasper, S., Vedula, S. S., John, S. S., Horo, S., Sepah, Y. J., & Nguyen, Q. D. (2013). Corticosteroids as adjuvant therapy for ocular toxoplasmosis. The Cochrane database of systematic reviews, 4.

Corticosteroids as adjuvant therapy for ocular toxoplasmosis. / Jasper, Smitha; Vedula, Satyanarayana S.; John, Sheeja S.; Horo, Saban; Sepah, Yasir J.; Nguyen, Quan Dong.

In: The Cochrane database of systematic reviews, Vol. 4, 2013.

Research output: Contribution to journalArticle

Jasper, S, Vedula, SS, John, SS, Horo, S, Sepah, YJ & Nguyen, QD 2013, 'Corticosteroids as adjuvant therapy for ocular toxoplasmosis.', The Cochrane database of systematic reviews, vol. 4.
Jasper, Smitha ; Vedula, Satyanarayana S. ; John, Sheeja S. ; Horo, Saban ; Sepah, Yasir J. ; Nguyen, Quan Dong. / Corticosteroids as adjuvant therapy for ocular toxoplasmosis. In: The Cochrane database of systematic reviews. 2013 ; Vol. 4.
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