Biologicals in uveitis

Abstract

Most noninfectious uveitis appears to be autoimmune or autoinflammatory in nature, requiring treatment with immunosuppressive and/or anti-inflammatory drugs. Inflammatory uveitis is a difficult condition to treat. Recently, a new class of drugs obtained by a biological process and therefore defined as biologics has been successfully used in the treatment of immune-mediated rheumatic diseases. These drugs target different proinflammatory cytokines including tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), and IL-6 or immune effector cells including B- and T-lymphocytes. The success in rheumatology of the TNF-α inhibitors adalimumab (ADA) and infliximab (IFX) over the past several years has led to their use in uveitis, in particular in patients with Behcet's disease and for early use in patients with juvenile idiopathic arthritis who have not benefitted from methotrexate. The first experience with anti-TNF inhibitors etanercept, IFX, and ADA gave us excellent results in uveitis. Other newer biologics approved by the United States Food and Drug Administration for rheumatic diseases are emerging treatments for uveitis. These include the anti-CD20 inhibitors rituximab, the anti-TNF inhibitors certolizumab and golimumab, the IL-6 inhibitor tocilizumab, the IL-1 inhibitor anakinra, the cytotoxic T-lymphocyte antigen 4 inhibitor abatacept. Uveitis, a significant cause of ocular morbidity worldwide, is undergoing major changes as biologic therapies have entered into the field. We used PubMed and CrossRef (Google) search engine as the main source of information. In this review, we outline the ideal characteristics of drugs for uveitis and review the data to support the use of current and emerging biological therapies in this context.