Immune Checkpoint Inhibitor-associated Uveitis: Review of Treatments and Outcomes

ABSTRACT

Purpose: Immune checkpoint inhibitors (ICPIs), novel immunotherapy agents employed in the treatment of metastatic melanoma and other solid tumors, are associated with immune-related adverse events, including ocular inflammation. We review the current literature on immune checkpoint inhibitor-associated uveitis (ICIPU).

Methods: A comprehensive literature review utilizing MEDLINE/PubMed, Cochrane, and Web of Science databases was conducted. One hundred and twenty-six cases of ICPIU reported in the literature prior to January 31, 2020 were identified and reviewed.

Results: ICPIs were associated with 126 cases of anterior uveitis, intermediate uveitis, posterior uveitis, and panuveitis from 67 reports in the literature. Patients typically developed intraocular inflammation a median of 9 weeks after initiation of ICPI and 83.6% of the patients developed uveitis within 6 months. The vast majority of patients recovered to within one line of baseline vision in response to topical, local, and/or systemic steroid treatment as well as the cessation of medication.

Conclusions: Prompt recognition and steroid treatment of ICPIU are critical to the care of patients receiving ICPIs.

KEYWORDS:

• Immune checkpoint inhibitor
• uveitis
• ipilimumab
• pembrolizumab
• cemiplimab
• nivolumab
• atezolizumab
• avelumab
• durvalumab
• CTLA-4 inhibitor
• PD-1 inhibitor
• PD-L1 inhibitor

Acknowledgments

We acknowledge Antonia Osuna-Garcia for her contributions to the literature search.

Additional information

Funding

The authors have no conflict of interest or financial disclosures. This work is supported by an Unrestricted Grant from Research to Prevent Blindness, Inc., to the Department of Ophthalmology at UCLA.