Abstract
Non-infectious uveitis (NIU) represents one of the leading causes of blindness in developed countries. The therapeutic strategy aims to rapidly control intra-ocular inflammation, prevent irremediable ocular damage, allow corticosteroid sparing and save the vision, and has evolved over the last few years. Anterior NIU is mostly managed with topical treatment in adults. However, for intermediate, posterior and pan-uveitis, notably when both eyes are involved, systemic treatment is usually warranted. Biotherapies are recommended in case of inefficacy or non-tolerance of conventional immunosuppressive drugs in non-anterior NIU. Anti-tumor necrosis factor alpha (anti-TNF-α) agents are by far the most widely used, especially adalimumab (ADA) and infliximab (IFX). In case of sight-threatening uveitis in Behçet’s disease or in case of risk of severe recurrences, respectively IFX and ADA may be recommended as first-line therapy. Many questions are left unanswered; how long to treat NIU, how to discontinue anti-TNF-α agents, what biologic to use in case of anti-TNF-α failure? The objective of this review is to present an updated overview of knowledge on the use of biological treatments in NIU.
Highlights
Adalimumab and infliximab were mostly studied in uveitis treatment [20]
ADA is approved by the Food and Drug Administration (FDA) and the European Medicine Agency (EMA) for the treatment of patients suffering from non-infectious non-anterior uveitis (NINAU) in case of cortico-dependence or contraindication to corticosteroid
Deodhar et al observed that the incidence rate of uveitis in patients treated with secukinumab for an ankylosing spondylo-arthritis was not increased, compared to other treatments such as anti-TNF-α agents [113]
Summary
One third of patients have non-infectious inflammatory uveitis [3] This inflammation can be systemic (sarcoidosis, Behçet’s disease) or limited to the eye (birdshot chorioretinopathy) [4]. Uveitis appears as the fifth most common cause of visual loss in developed countries, affecting young people (60–80% of patients are between 20 and 50 years old) [6] This poor visual prognosis is secondary to the development of ocular complications. The Systemic immunosuppressive therapy for eye diseases (SITE) cohort studies [9] have shown the efficacy of methotrexate [10], mycophenolate mofetil [11] and azathioprine [12] in resolution of intra-ocular inflammation and corticosteroid sparing effect. The aim of this review is to provide an updated understanding of the use of biological therapies in non-infectious uveitis
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