Anti-Tubercular Therapy in the Treatment of Tubercular Uveitis a Systematic Review and Meta-Analysis

Abstract

Background: Tubercular uveitis (TBU) is commonly treated with anti-tubercular therapy (ATT) and corticosteroid or immunosuppressive adjuncts. The objective of this meta-analysis is to quantitatively evaluate the efficacy of ATT in TBU patients. Methods: In this systematic review and meta-analysis, a search of PubMed, EMBASE and Cochrane Library was conducted for articles on ATT outcomes in TBU published between 1 st January 2000 and 1 st August 2021. Study details, demographics, clinical features, investigations that led to a diagnosis of TBU, treatment regimen (ATT, corticosteroids and immunosuppressants), and information on target treatment outcomes was extracted independently by three reviewers. A meta-analysis of proportions was performed. Main outcome measures include inflammation recurrence; inflammation reduction; complete resolution of inflammation; improved visual acuity (VA); ability to taper corticosteroids to < 10 mg/day without inflammatory progression; use of adjunctive immunosuppressants while on ATT. This review is prospectively registered in PROSPERO (CRD42020206845) Findings: Forty-nine studies reporting data for 4,017 TBU patients were included. In comparative studies, the odds ratio (OR) of inflammatory recurrence was 0.33 (95%CI: 0.19-0.60) for TBU patients treated with ATT versus no ATT. For TBU patients treated with ATT, the pooled absolute incidences of inflammatory recurrence, inflammatory reduction, complete resolution of inflammation and of visual acuity improvement were 13% (n=310/2,216; 95%CI: 9-18), 81% (n=217/276; 95%CI: 62-95), 83% (n=1,167/1,812; 95%CI: 77-89), and 65% (n=347/542; 95%CI: 51-78) respectively. Corticosteroids were tapered to <10 mg/day without inflammatory progression in 91% (n=326/395; 95%CI: 78-99) of patients, 9% (n=121/1,376; 95%CI: 6-13) of whom were administered concomitant immunosuppressive agents alongside ATT. Interpretation: Treatment of TBU with ATT is associated with a high level of control or improvement of inflammation, followed by a two-thirds improvement in the risk of inflammatory recurrence in TBU patients; only one-seventh of TBU patients have recurrences during follow up. Visual acuity improved in most patients. However, more prospective studies with detailed reporting of ATT regimens, patient subgroups and outcomes are required to elucidate the effectiveness of ATT about other outcome measures. Funding: None to declare. Declaration of Interest: B.K.B, I.P., I.T., R.L.D.N., C.P. and V.G. report no conflicts of interest, financial or propriety, in the subject matter or materials discussed in this manuscript. J.H.K. is a consultant for Gilead Pharma, a company evaluating a treatment for non-infectious uveitis, and equity owner for Betaliq, a company developing an intraocular pressure-lowering treatment. R.A. is supported by a grant from the National Medical Research Council (NMRC), Singapore, for the Clinician Scientist Award (CSA) from 2020-2023. He has not received funding for his work in this publication.