The use of biologic agents in the management of uveitis

Abstract

The uveitides are a heterogenous group of ocular inflammatory disorders that account for the third highest cause of blindness worldwide, responsible for 5–10% of visual impairment globally. Up to 35% of patients with uveitis can suffer significant vision loss. To prevent irreversible structural damage and blindness, it is important that the diagnosis and commencement of appropriate therapy occurs promptly. Management includes topical and systemic corticosteroid therapy and conventional immunomodulatory agents, including methotrexate, azathioprine, mycophenolate mofetil and cyclosporin. Significant progress has been made in the past decade in our understanding of the immunopathological pathways that drive intraocular inflammation, allowing the development of targeted therapy with biologic agents. These include TNF‐α inhibitors, such as infliximab, adalimumab and etanercept; interleukin blockers, such as tocilizumab and daclizumab; and other targeted therapies, such as rituximab and abatacept. The efficacy of these agents has been studied in cases of severe uveitis that are refractory to conventional immunomodulatory agents and provide exciting results that have revolutionised uveitis management. Though the biologic era has provided a large armamentarium to treat uveitis, ongoing challenges and cases of recalcitrant uveitis remain, posing a challenge to internal medicine physicians. This comprehensive review aims to construct an updated summary on the existing evidence pertaining to the use of biologic agents in the treatment of uveitis. Methods include a systematic search for studies between 2000 and 2018 using PubMed, EMBASE, Ovid MEDLINE and Cochrane libraries.

New Potential Weapons for Refractory Scleritis in the Era of Targeted Therapy

“…The advent of biologic therapy has revolutionized the management of noninfectious intraocular inflammation. However, most of the reported literature is primarily focused in the treatment of uveitis [14], whereas the efficacy and safety of biologics in scleritis have mainly been addressed by single case reports and small case series [6][7][8][9][10][11]15].…”

Biologic therapy for uveitis: addressing access issues is paramount

“…We read with interest the articles in the November issue of the Internal Medicine Journal in relation to advances in the treatment of uveitis, focusing on biologic therapies. 1,2 These agents have undoubtedly been a revolution in the treatment of a wide range of inflammatory diseases in neurology, nephrology, rheumatology, gastroenterology and now ophthalmology. These advances have been on the basis of large, often multi-national, clinical trials demonstrating their efficacy.…”

Biologic therapy for uveitis: a new beginning

“…This is indeed vision saving, life changing uveitis therapy. The article in the current issue of Internal Medicine Journal by Trivedi et al . is a timely and useful summary of the emerging role of biologic agents in the management of patients with uveitis.…”

“…Despite the heterogenous nature of uveitis, there have been several well designed prospective clinical trials and retrospective studies that are discussed in the review by Trivedi et al . and which provide useful guidance for the management of uveitis.…”

“…Although there are five available anti‐TNF biologics, most data and clinical experience have been gained using adalimumab and infliximab. These data are well summarised by Trivedi et al . Salvage therapy for patients who are poor or non‐responders to anti‐TNF is usually with tocilizumab, other anti‐TNF biologics and occasionally with rituximab .…”