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ABSTRACT
Introduction
The treatments for noninfectious uveitis (NIU) include topical steroids, local steroid injections, and systemic steroids or immunomodulatory agents. Over the last 20 years, there have been advancements in both conventional and alternative complementary therapies for uveitis. In this review, we will give an overview of the current conventional and alternative systemic treatments for NIU and discuss the possible risks and benefits to each.
Areas Covered
Conventional systemic therapies for NIU include corticosteroids, antimetabolites, biologics, calcineurin inhibitors, alkylating agents, janus kinase (JAK) inhibitors, and interferons. Alternative therapies include Ayurvedic medicine, berberine, glycosides, Traditional Chinese medicines, dietary changes, and vitamin supplementation.
Expert Opinion
There are an expanding number of systemic treatments for NIU. Over the last 15 years, biologic agents in particular have expanded and improved treatment options for patients with NIU.
Article highlights
Conventional systemic treatment options for noninfectious uveitis (NIU) include corticosteroids, antimetabolites, biologics, calcineurin inhibitors, alkylating agents, JAK inhibitors, and interferon.
Biologics have grown in popularity over the past 15 years as clinical trials have validated their efficacy in treating NIU refractory to steroids with less adverse effects than calcineurin inhibitors and alkylating agents.
Alternative therapies for NIU include Ayurvedic medicines, berberine, glycosides, traditional Chinese medicines, dietary changes, and vitamin supplementation.
Curcumin is the first alternative therapy for NIU that demonstrated some efficacy in reducing ocular inflammation and uveitis relapses in a clinical trial.
There is limited information about alternative medicines, necessitating further investigation into their safety, efficacy, and potential interactions with conventional therapies.
Factors to consider when deciding on treatment options are individual patient needs, disease severity, and response to previous therapies.
Abbreviations
| NIU | = | noninfectious uveitis |
| UME | = | uveitic macular edema |
| IMT | = | immunomodulatory therapy |
| CAM | = | complementary and alternative medicine |
| VKH | = | Vogt-Koyanagi-Harada |
| IVM | = | intravenous methylprednisolone |
| GI | = | gastrointestinal |
| MMF | = | mycophenolate mofetil |
| JIA | = | juvenile idiopathic arthritis |
| TNF | = | tumor necrosis factor |
| IVIg | = | intravenous immunoglobulin |
| IL | = | interleukin |
| JAK | = | janus kinase |
| IFN | = | interferon |
| TGP | = | total glucosides of paeony |
| TWP | = | Tripterygium wilfordii polyglycosides |
| LXT | = | Longdan Xiegan Tang |
| QKL | = | Qian Kai Ling |
| QHRG | = | Qing Huo Rou Gan |
Declaration of interests
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.