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The aim of this study is to determine the proportion of clinical improvement, the score changing of type 1 interferon selected gene expression, and analysis of transcriptomics profiling in patients with idiopathic uveitis positive IGRA before and after receiving Anti-Tuberculosis Therapy (ATT).
Hopefully, by conducting this research, we are able to provide valid data that demonstrate the advantages/disadvantages usage of Anti-Tuberculosis Therapy in patients with idiopathic uveitis IGRA positive that correlate with type I IFN. This research is a part of our efforts in discovering bio-marker candidates of idiopathic uveitis IGRA positive clinical patients who will benefit from the ATT administration.
Diagnostic of Idiopathic Uveitis IGRA Positive patients were still unclear. This situation happens because it is still can't be explained if the uveitis from the patients was caused by mycobacterium tuberculosis or not which leads to doubtfulness for Anti-Tuberculosis Treatment (ATT). This study aims to help to provide evidence on whether ATT usage for Idiopathic Uveitis IGRA Positive would bring beneficial impact for the patients. This study will try to analyze the data from clinical improvements, Type 1 Interferon changes, and transcriptomics analysis from the patients.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Observational cohort group | Subjects: idiopathic uveitis with IGRA positive. Examinations:
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Fixed drug combination (FDC) of ATT and Oral steroid | Drug | In the first two week, patients receive FDC of ATT only. Oral steroid start to be given in week three. The ATT regiment is continued for up to 6 months or more, in accordance with WHO guidelines. In the first two months the antibiotic combination given consisted of isoniazid (INH), rifampicin, pyrazinamide, and ethambutol. The next four months or continuation phases, the ATT given is rifampicin and isoniazid. The following dosage and administration of oral steroids will be given to patients, according to guidelines from the American Journal of Ophthalmologists (Douglas A. Jabs et al, 2000): Initial dose: 1mg/kg/day, with maximum adult oral dose 60-80 mg/kg and maintenance dose less than or equal to 10 mg/day. The tapering schedule: Over 40 mg/day, decrease by 10 mg/day every 1-2 weeks, 40-20 mg/day, decrease by 5 mg/day every 1-2 weeks, 20-10 mg/day, decrease by 2.5 mg/day every 1-2 weeks, 10-0 mg/day, decrease by 1 to 2.5 mg/day every 1-4 weeks. |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of clinical improvement | Clinical improvement of uveitis patients with IGRA positive after receiving complete Anti Tuberculosis Therapy is measured by using The Standardization of Uveitis Nomenclature (SUN) inflammation degree. Clinical improvement definition is decreasing of inflammation degree up to two degrees or becoming 0 degree. Meanwhile, clinical failure is defined by increasing of inflammation degree or decreasing of inflammation degree up to one degree/ not becoming 0 degree or unchanged degree of first to fourth degree. | 0, 14 days, 8 weeks, 3 months, 6 months, and 12 months |
| The changes of type 1 interferon scoring in selected gene expression | The score changes of type 1 interferon of uveitis patients with IGRA positive are determined by gene expression value of 10 varieties of type 1 interferon using Quantitative Reverse Transcriptase PCR (RT-qPCR) testing. | 0, 14 days, 6 months. |
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Inclusion criteria:
Subjects who will be recruited to this study are patients who met the criteria described below:
Registered patients from September 2019 at Cipto Mangunkusumo Hospital
Idiopathic uveitis patients (proven having negative result by available etiological uveitis work-ups) with IGRA positive. IGRA positive value is defined by score above 0.35 u/ml obtained from Quantiferon Tuberculosis (QFT)-Gold Assay (QIAGEN).
Minimum age: 18 years old
Proven not having active Tuberculosis
Not previously received Anti Tuberculosis Therapy.
Not consuming antibiotic one to two weeks prior to the time of study
Not living together with Tuberculosis active patient
Not having plan to become pregnant during the time of study
Not part of reactive Tuberculosis risk group based on Latent Tuberculosis Incident WHO guidelines 2018
Active inflammation in the past 180 days characterized by the following sign based on SUN Criteria(in at least one eye)
Active inflammation during patient registration, characterized by the following sign based on SUN Criteria (in at least one eye)
Exclusion Criteria:
Note (^): Testing is conducted within 1-2 weeks prior to enrollment;
As many 10 subjects of the health volunteers are recruited for this study after giving consent. The health volunteers that will be recruited are the subject who met following criteria:
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Idiopathic uveitis patients with IGRA positive registered from September 2019 at Cipto Mangunkusumo Hospital
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Rina La Distia Nora | Contact | +62811-198-910 | rina.ladistia@ui.ac.id |
| Name | Affiliation | Role |
|---|---|---|
| Rina La Distia Nora | Division of Ophthalmology Departement, Faculty of Medicine Universitas Indonesia | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| RSUPN dr. Cipto Mangunkusumo (Cipto Mangunkusumo Hospital) | Recruiting | Jakarta Pusat | Jakarta Special Capital Region | 10430 | Indonesia |
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Whole blood from the patients are collected in PAXgene blood RNA tubes (QIAGEN). The RNA from the whole blood is extracted and proceed for further examinations (type 1 interferon expression and transcriptomic analysis).
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| ID | Term |
|---|---|
| D014376 | Tuberculosis |
| D014605 | Uveitis |
| ID | Term |
|---|---|
| D009164 | Mycobacterium Infections |
| D000193 | Actinomycetales Infections |
| D016908 | Gram-Positive Bacterial Infections |
| D001424 | Bacterial Infections |
| D001423 | Bacterial Infections and Mycoses |
| D007239 | Infections |
| D014603 | Uveal Diseases |
| D005128 | Eye Diseases |
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| ID | Term |
|---|---|
| D013256 | Steroids |
| ID | Term |
|---|---|
| D000072473 | Fused-Ring Compounds |
| D011083 | Polycyclic Compounds |
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