Therapeutic options for the treatment of non-infectious uveitis

Abstract

Non-infectious uveitis encompasses a group of site-threatening intraocular inflammatory diseases. Several classes of immunosuppressive medications, including corticosteroids, T cell inhibitors, antimetabolites and, more recently, biologic agents have been shown to be effective in reducing intraocular inflammation in non-infectious uveitis. However, these agents also pose significant risks if not administered and monitored properly. Further research into the pathogenic mechanisms of non-infectious uveitis will hopefully aid in the development of more targeted and safer therapies.

Keywords:

• antimetabolites
• biologic agents
• corticosteroids
• immunosuppression
• inflammatory eye disease
• T cell inhibitors
• uveitis

Financial & competing interests disclosure

This research was supported by intramural funds from the National Eye Institute, National Institutes of Health. 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.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Uveitis represents a group of site-threatening inflammatory eye diseases that may be of infectious or non-infectious etiology.

• For non-infectious uveitic entities, aggressive immunosuppression is required in an attempt to minimize inflammatory damage to the ocular structures.

• Systemic corticosteroids remain integral in the treatment of non-infectious uveitis because of their broad immunosuppressive effects and rapid onset of action.

• Topical corticosteroids may be used for anterior uveitis, while periocular or intravitreal corticosteroids have much better efficacy for the posterior segment inflammation.

• In patients with poor response to corticosteroids or, especially, in destructive inflammatory eye diseases, such as Behçet’s disease and granulomatosis with polyangiitis, steroid-sparing therapy is required.

• Anitmetabolites, including methotrexate and mycophenolate mofetil, T cell inhibitors, including cyclosporine A and tacrolimus, and anti-TNF agents, including infliximab and adalimumab, are the commonly used steroid-sparing agents in the treatment of inflammatory eye disease.

• Patients on systemic immunosuppression require routine surveillance to be monitored for development of potentially harmful medication-induced side effects.